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A Case For (and Against) Saturdays

This week on the podcast…

Leslie Mamalis, Senior Consultant at Summit Veterinary Advisors, joins Dr. Andy Roark to walk through how she advises veterinary clinic owners or leaders on how and when to consider closing on Saturdays.

ABOUT OUR GUEST:

Leslie is the Senior Consultant with Summit Veterinary Advisors, a nationally recognized business consulting firm. Leslie’s specialties include practice valuations, profitability assessments, feasibility analyses, and transition planning for veterinarians across the country. 

Leslie has an MBA and an MS in Information Technology and became a Certified Valuation Analyst in 2013. She worked for the American Animal Hospital Association (AAHA) for seven years, beginning with management education seminars and then becoming involved with the accreditation program. She is a member of the National Association of Certified Valuators and Analysts, the Veterinary Hospital Managers Association, VetPartners, and the VetPartners Valuation Council.  

Ms. Mamalis is an author and frequent speaker on practice value, profitability, and owner transition. She is an original columnist in Today’s Veterinary Business. Leslie has extensive experience helping veterinarians and managers understand financial reports so they can use that information to increase practice profitability and value. 

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

Submit your questions here: unchartedvet.com/mailbag

Episode Resources

Summit Veterinary Advisors – https://summitveterinaryadvisors.com/

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

Episode Transcript

Dr. Andy Roark:
Welcome, everybody to the Uncharted Veterinary Podcast. I'm your host, Dr. Andy Roark. I actually, I made this podcast, guys, the one you're listening to right now with my friend, Leslie Mamalis, and I was going to put it out through my Cone of Shame Veterinary Podcast. It's a podcast I talk about what's going on in medicine and I tend to have guests on and do interviews, and I really liked this interview with Leslie a lot, and I was talking to Stephanie Goss about the case for and against Saturdays, and she said, “That's an Uncharted podcast, Andy.
These are the types of management decisions that we work on and weighing the pros and cons and looking into how to make decisions about when we're open and what we do with our hours, I think that's a great Uncharted episode,” and so she really, she twisted my arm and so I'm going to put this out as an Uncharted podcast. Guys, I hope that you'll love it. It's a little bit shorter than our regular Uncharted podcast, but I think it's a really, really good one. Leslie's amazing. She is a senior consultant at Summit Veterinary Advisors, and I give her more of an introduction when we get into the episode. Guys, let's get into this.

Speaker 2:
And now, the Uncharted Podcast.

Dr. Andy Roark:
Welcome to the podcast, Leslie Mamalis. How are you?

Leslie Mamalis:
I'm doing great, Andy. Thank you so much for having me.

Dr. Andy Roark:
It's my pleasure. So I was checking and confirming your title before you came on, and it is Queen of the Universe.

Leslie Mamalis:
It is, yes.

Dr. Andy Roark:
Okay, good. Boy, I got to tell you, the quality of guests I'm getting on this podcast just keeps going up. It's amazing.

Leslie Mamalis:
You're moving up in the world.

Dr. Andy Roark:
Really pulling them in. As a queen of the universe, Leslie Mamalis, you are also, when just have free time, you are senior consultant at Summit Veterinary Advisors.

Leslie Mamalis:
That's right. That's right. Summit just celebrated 25 years too so it's tradition.

Dr. Andy Roark:
You and I have known each other for a long time. We've been on the speaking circuit together doing practice management stuff and things like that. You write a column that I really enjoy in Today's Veterinary Business. I like to read your stuff on practice and practice management, and you had a column not long ago, that was The Case for and Against Saturdays, and I enjoyed it. I think that there's a lot of value in coming with a balance of saying, well, sometimes this makes sense and sometimes it doesn't.
I think a lot of people have really felt shoehorned into Saturdays. I think the pandemic was a really interesting shakeup time when people started to really question, wait a second, what are we doing and how much do we have to do and what do people really want, and so I wanted just to go through the exercise with you of evaluating the case for and against Saturdays if you're a small animal medical practice. Is that okay?

Leslie Mamalis:
Absolutely. Absolutely. And just as you're saying, there's been pretty significant social changes over the past few years that are making veterinarians reconsider Saturdays and office hours in general.

Dr. Andy Roark:
Well, talk to me about that. Let's just start at a high level. Why are we having this conversation? What are the social changes you're referring to?

Leslie Mamalis:
Well, for forever, veterinary practices were open six days a week or five full days, plus Saturday mornings at least, sometimes later, and that has been the expectation for eons because you needed to be available for clients who needed to come in on Saturdays because they were working. Well, with the pandemic, oh my gosh, things changed so much because for one thing, some practices weren't open at all for a period of time and then there had to be so much caution taken with segregating staff, making sure that the employees were safe and healthy so that you could continue to have the practice open, and Saturdays just were not feasible. It was so hard to staff Monday through Friday, and frankly, clients weren't going anywhere. There weren't going into the office frequently, kids weren't at school, there weren't after school activities.
Social life really got very quiet for a long time, and so veterinary practices who closed on Saturdays because of the pandemic now have come out of that and wondered, should we reopen, and honestly, during the pandemic, I think a lot of people got back to what really matters in their life and they enjoyed having a little slower pace, and Saturdays became family time or personal time and not time to run around doing errands or working, and the value that comes from having two consecutive days off is tremendous. If you have just one day off a week or you have one day off and not the following day, you're spending that day doing errands, doing chores. You're not getting any time to relax and refresh. By having two days in a row though, you can accomplish all of those must-dos and also have time for yourself and your family.

Dr. Andy Roark:
Do you see a labor shortage in veterinary medicine and do you think that contributes to the idea to either not do Saturdays or to continue, or to either drop Saturdays or to continue not doing Saturdays? So I don't want to make too many assumptions. When you're shorthanded, I feel like people look for reasons. One is how do we make it go with the staff that we have, but then I also, I can go from there into recruiting people and is that a perk that people like is not having to work on Saturdays, and so is that hooey? Is that made up, or do you think that's real?

Leslie Mamalis:
I think it's real. I think maybe we're taking it a little farther than reality truly suggests, but is there a labor shortage? I think there's a labor shortage in almost every industry right now, and it's not that there aren't enough people. It's that people don't want to work as much as they used to because they're not seeing the value. The money isn't as important for whatever reason, and that's true even now that so many of the government incentives and extended unemployment, et cetera, those benefits have ended, but we're not seeing a rush of people back to, especially some of the less skilled jobs.
And I'm not seeing that there are many unskilled jobs in veterinary medicine, but if you look at fast food or retail, something like that where you don't have to undergo a lot of training in order to do work, there's still not a rush to go back to those jobs. So I also believe that it can be a shortage of people who want to work for what you're paying, and that certainly has changed somewhat in veterinary medicine because practices have had to pay more to keep people, and honestly, high time. It's time that veterinary medicine wasn't the underpaid profession, especially for veterinary nurses, for receptionists, for veterinary assistance. People should be able to make… I'm sorry, I'm really going off on a tangent here.

Dr. Andy Roark:
No, no, go ahead. I love it.

Leslie Mamalis:
So people need to be able to work at a veterinary practice and support themselves and their families. So it was important and a very necessary change that wages have increased. They needed to, absolutely, because I'm tired of seeing good people leave the profession because they can make more money doing something else.

Dr. Andy Roark:
Sure. I think all that makes sense. Let's go with this a little bit and let's just say that I am the owner of a three doctor practice and I have increased wages for my staff, so I've got a bigger payroll than I've had before, you know what I mean? I'm able to retain people the way that I've wanted to, and the staff has brought me this idea that maybe we don't need to be open on Saturdays, and so maybe my kids are young and then I would like to have two consecutive days off as much as anybody.
Walk me through how you would advise me here. So Leslie, I brought you in and I say, “I'm looking at this. I don't really know where to start. It's a scary thing. I know that Saturday is my busiest day. I know that people show up. The idea of not being here is scary, and at the same time, I would really like to not be here and people are telling me, ‘oh, don't worry. The clients will come on other days,' and I don't know if that's true. I've got at least a couple of people who have told me they're not coming if I'm not open on Saturdays.” How do you walk me through a decision making process?

Leslie Mamalis:
Absolutely. Absolutely. So we need to start from where are you located because if you're in Denver like I am, it's a different decision than if you're in Lander, Wyoming where I grew up and it's about 10,000 people and there are two veterinary practices. So if closing on Saturday is not going to impact your clients or your community in a negative way such that it outweighs the benefit that your practice will get, then that's one decision, and I'll talk a little bit more about that. So if you're in a metropolitan area and there are emergency clinics that are open on weekends, open during the evening, it's less of an issue for you to close your practice on Saturdays.
So yes, there are absolutely clients who need to come in on Saturday, whether it's because they just prefer to come in on Saturday or they cannot get in because they cannot get time off work or they've got little kids at home, or there's some reason why they can't come in. So there are so many things that go into a decision related to closing on Saturdays. So certainly, there's the doctors and staff at your practice, there's your clients and what their needs are, and then there's the community needs, and we need to consider all of those together.

Speaker 4:
Hi, friends. Do you struggle with finding the right cadence for team meetings in your practice? Do you feel like maybe you're meeting not enough or maybe you're meeting too often and you're stuck in meeting hell? I feel you. Finding that balance, trying to work on improving communication, make sure everybody stays on the same page and getting things done in a busy vet practice is really, really hard, but we've got a solution for you. Join the Uncharted community on July 1st, 2023 from 4:00 to 6:00 PM Eastern Time. That's 1:00 to 3:00 PM Pacific for an Uncharted workshop presented by my friend and colleague, Maria Pirita.
She's a CVPM and if you've not met Maria before, you are in for a spicy treat. She is amazing and she is super excited to kick off the conversation, talking about team meetings with her take on making them effective and efficient. That's right. It's called Effective and Efficient Team Meetings. It's $99 to register, but it's free for our Uncharted members. Now, if you've never been to an Uncharted workshop before, this is not your traditional webinar where the presenter or the speaker sits there and talks at you for an hour. The goal for our community workshops is to make them live.
We don't want you to sit silently in front of your screen. We want you to be engaged and interacting for the one to two hours that you're meeting with our speakers to have the chance to ask your questions, to talk to your peers, and interact with other rockstar veterinary professionals because that's what you are, and we want to see you there. So head on over to unchartedvet.com/events to sign up for this workshop and check out what's coming because we've got a bunch of stuff coming up in the future that you don't want to miss, and now, back to the podcast.

Leslie Mamalis:
Saturdays so often are a pain in the butt to schedule, not for the clients, but for the staff. Doctors don't want to work Saturdays, staff don't want to work Saturdays, and too often, the Saturday shifts end up with people calling out for whatever reason, and so the people who are left working, they're overburdened, and after a while, that becomes to feel really unfair. The other thing is if for those clients who have Saturday appointments, if they're coming into a practice that's now understaffed, their experience is not going to be nearly as positive as it might be during the week, and Saturdays can absolutely become crazy.
Some Saturdays are nice and everything works really well, and staff show up, clients are on time, nobody has an issue, but those Saturdays are so few and far between. It's much more likely that Saturdays are going to be crazy. There's going to be a mob scene because you're going to have clients who have to come in today, can't possibly wait until Monday, refuse to go to the emergency clinic for whatever reason. Perhaps it's because it's really not an emergency. So often, the stress level in the practice goes up, the quality of client communication and client care goes down.
Patient care, I'm going to hope is always good. May not be absolutely what you wanted it to be, but it's always good care. It's the client that gets the raw end of that deal, either through needing to wait much longer than they expected for their appointment or they're not getting the attention they expected, they're not getting the full explanation maybe from the receptionist, et cetera. So that can be difficult. For staff, I never minded working Saturdays when I knew that I was going to go in and come out and at the time I expected, but I would work my shift and go home.
So often, that doesn't work though because you've got to stay late to finish appointments, deal with that emergency or transfer the case to the emergency clinic. You've got to clean like crazy and you're there for two or three hours later than you expected to be. Once in a while, that comes with the territory of working in veterinary medicine. Once in a while, that's not a big deal. Every time, that becomes a big deal and so you start getting dissatisfaction and disgruntlement with staff. People start resenting working on Saturdays and which makes it even harder to schedule them.

Dr. Andy Roark:
Okay, this is not the argument I thought you were going to make, which is interesting. I think all this makes sense and I have 100%, I was lamenting recently, I was working in the clinic on a Saturday and we were really busy and I had some people who went up to the front desk and they were like, “Is Dr. Roark always so rushed? We didn't feel like we got to ask him these questions,” and they had a pet with allergies and they had transferred from another vet, and it was just interesting in that I was doing my best to try to keep up with the flow of patients coming in and I didn't have time to sit down and do the whole allergy talk with them.
And so I tried to specifically answer their questions and then I was onto the next room, and it bothered me because I thought their critique was valid. I really did, and at the same time, I don't know what I would do differently because I had other sick patients and so I was really pinched, and it was one of those ones where I rolled around and I go, I see their criticism. I see its validity. I don't know what I would do differently if I was back in that position, and that always bothers me as systemically, it feels broken, and so it's interesting to me that you say, well, all these things happen.
And I see them all, you're exactly right, the staying in the afternoon, the people calling out, and then we're shorthanded and we're still dealing with this, the dump truckload of stress, but they're all tied around this being a really popular day, and so I have a hard time teasing those two things apart. If I was this practice owner, I'm looking at you and saying, wow, but these are all problems of popularity and people wanting the service. Are there things that you can do to help assuage my fears that the biggest day of the year, if I just stop doing it, that all that revenue's going to go away? How do you help people not grab onto that idea and just cling to it?

Leslie Mamalis:
Sure, and that can be difficult. So my recommendation would be start by closing every other Saturday. If you're really worried about losing a lot of revenue because you're not open on Saturdays, start by closing every other Saturday and look at other times during the week when you may be able to expand hours. So could you stay open until 7:00 or 8:00 one night a week? Could you open a little bit earlier? Could you do more to encourage people to use drop-off appointments? Are there other ways that you can move cases during the week, but allow your clients to still have the flexibility of dropping that pet off and not needing to take time off of work or to still get their kids to school on time?
So certainly, looking for other places during the week where perhaps you could expand hours. Many of the practices we work with work half days on Wednesdays. Could you open Wednesday afternoons, and again, just adding even if you stayed open until 6:00 or 7:00, assuming that you… I'm surprised by the number of clients I work with that are open 9:00 to 5:00. I kind of wonder, when would I take my pet then, but if you're open 9:00 to 6:00, could you stay open until 7:00 twice a week and just stagger employees. If you're not doing telemedicine, so many practices had an immediate turn to telemedicine during the pandemic and a lot of them have stopped.
It's like, why, because if you can do telemedicine, now I don't have to worry about juggling my three cranky cats and trying to get them into the practice during the week right after work, right before work. So finding ways to use telemedicine, finding ways to use more technician appointments, finding ways to just expand the ability of the practice to serve clients with existing staff and also in existing office hours. Now some people are going to leave, absolutely, and unfortunately, a couple of those people are going to be people that really surprise you. They're the ones that you've really enjoyed working with, but for whatever reason, they just can't fit into your hours. That's okay. We have to let it be okay for clients to choose to go somewhere else and not take it as a crushing blow to our egos.

Dr. Andy Roark:
Easier said than done.

Leslie Mamalis:
Absolutely. Absolutely.

Dr. Andy Roark:
But yes, you're right, but oh boy, that hurts.

Leslie Mamalis:
It does.

Dr. Andy Roark:
Oh, man.

Leslie Mamalis:
It absolutely does, but if you can have a calmer environment, happier staff who are more engaging with clients, it will be easier to replace the clients that you lost by not being open on Saturdays. So by starting to just taper Saturday hours so that you're open every other week instead of every week. Gosh, look back to what people were doing prior to easy access to emergency care. Veterinary practices, you rotated. It's like you got together with a group of your colleagues and everybody picked a weekend and you were on call that weekend and it worked. So sometimes it's okay to go back to what worked long before you were a veterinarian, just because if people really need access on Saturdays, they can still get that care.

Dr. Andy Roark:
I think this really speaks to a fundamental philosophic shift that I think a lot of people have gone through, and I think you put your finger on the very beginning of going back to the pandemic and people spending some time at home and starting to think about what they wanted their lives to be like and things like that. I always thought in my thirties especially, I was pretty darn convinced that bigger was better. You wanted to have more doctors, you wanted to be open more days, more hours, see more patients.
And that's what success was, was this escalation of service capabilities and service providing to the public and that was where the success path went, and I remember I was running strategic planning for this veterinary practice owner and I was talking to her about where she saw herself in 10 years, and I was like, “What's your big plan? Where does this look in 10 years,” and she said, “Andy, I have a three vet practice and I love it, and I don't want any more vets and I don't want any more clients. I want to do what I'm doing now and I would like that to be simpler. I would like it to be easier for me to do what I'm doing now,” and that absolutely broke my brain at the time.

Leslie Mamalis:
Absolutely, absolutely. Because we've all been taught that bigger is better and if you're not moving, if you're not growing, you're in trouble, right?

Dr. Andy Roark:
Yeah, exactly. And this is a conscious movement away from that. This is consolidation to say, no, we're going to see a little bit less. We're going to ratchet this down. We're going to have more time away from the business, and I really do think that's a very modern idea and I think it's probably a really healthy one. Leslie, thanks so much for being here and thanks for talking through this with me. I really appreciate your time. Where can people find you online? Where can they read more of your stuff? Where can they learn more?

Leslie Mamalis:
Sure. Summitveterinaryadvisors.com is our website. We're on Facebook and the Insta, and you can find my articles on Today's Veterinary Business. I write the Money Matters column.

Dr. Andy Roark:
Excellent. Well, guys, thanks so much for tuning in. Leslie, thanks so much for being here. Take care of yourselves, everybody. And that's it, guys. That's the episode. That's what I got for you guys. I hope you enjoyed Leslie. Again, I really appreciate her. She's wonderful to work with. She's so insightful and so, gang, anyway, Stephanie Goss and I will be back for you next week doing our regular thing. Can't wait to talk to you then. All right. Take care of yourselves. Be well. Bye.

Are We Still Doing Non-Competes?

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are in the mailbag with a question that might just light this episode on fire. An associate vet who is thinking ahead to owning their own practice is asking if they are nuts for considering throwing away the non-compete option someday as a practice owner. Especially when they view it in light of their own personal experience trying to separate from a toxic practice they found themselves in! Andy and Stephanie have some fairly strong opinions on this one so hang on folks, let's get into this…

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

Submit your questions here: unchartedvet.com/mailbag

Upcoming Events

June 21, 2023: Teaching Strategies That Foster Team Learning and Development with Josh Lucas

This event is for Uncharted Members. Learn more about teaching strategies for your team from former teacher-turned-practice-manager Josh Lucas. This is a members-only event. Join the Community for more content like this coming soon!

July 1, 2023: Effective & Efficient Team Meetings with Maria Pirita

Have you ever felt like your team would benefit from meeting more often, or maybe a little less often? Do you struggle to find techniques that truly make your team meetings effective? Find the right balance in this workshop.

Episode Transcript

Stephanie Goss:
Hey, everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. This week we're diving into the mail bag, but we're picking out a letter. This one was kind of handpicked because I had a wonderful time talking about this exact topic with some of my peers last week at our Uncharted April Veterinary conference. So we're recording this, this isn't coming out until the end of May, but I was having this conversation about non-competes and feeling pretty fiery about it and lo and behold, there was something in the queue from the mail bag from an associate vet who is asking the question, “Am I kind of on planet crazy to consider one day, when I own my own practice, not having non-compete be a thing in that practice?” Andy and I have some strong thoughts on this topic, so let's get into this one, shall we?

Speaker 2:
And now the Uncharted Podcast.

Andrew Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie, a kiss is not a contract, Goss.

Stephanie Goss:
That time you weren't ready.

Andrew Roark:
No, I… Okay. I was like, “Yeah, no, we're going.” And then I didn't. I double took. Yeah, A Kiss is Not a Contract actually is a song by Flight of the Conchords who I love.

Stephanie Goss:
I've not heard from those guys in a hot minute.

Andrew Roark:
Oh no. I still listen to the classics. Business time, still makes me just laugh.

Stephanie Goss:
Oh man.

Andrew Roark:
Oh man, I celebrate their collection. Oh boy.

Stephanie Goss:
How's it going?

Andrew Roark:
Oh man, it's good. It's good. It's raining here and so I've got a rowdy doodle that-

Stephanie Goss:
Wants to go out.

Andrew Roark:
That's determined to just make havoc because he can't go out.

Stephanie Goss:
Yes.

Andrew Roark:
So yeah, he woke up-

Stephanie Goss:
Shockingly it is also raining in Washington.

Andrew Roark:
Oh wow. Yeah. Oh, well, works out sometimes.

Stephanie Goss:
Because it's always raining here.

Andrew Roark:
Yeah, no. It's been beautiful.

Stephanie Goss:
Yeah.

Andrew Roark:
We're getting into the summertime in South Carolina at this point when it's coming out and boy, it's beautiful here, but it's nice to get a little bit of rain.

Stephanie Goss:
Yeah. Well, I am excited. I picked this one out of the mail bag. You guys have been doing a great job of sending in questions because there's quite the little queue built up in there, but I was having some conversation… Our Uncharted April event, when we're recording this, you and I just finished that last week and we're having some conversation about this topic and when I saw this mailbag question, I was like, “Ooh, let's do that one,” because I'm still super, super excited about it. So we got an email from someone who is currently an associate vet, but who is wanting to become a practice owner. And so they had quite a toxic environment that they were working in and quit their practice and the resulting interactions between themselves and the practice owner as they were exiting that practice left them thinking ahead to what they don't want to do one day when they're a practice owner.
And so their specific questions have to do with employment contracts and non-competes. So they were saying, “I find non-competes to be a little bit outdated, especially since I live in a pretty dense urban area. The non-solicitation piece I totally get, but who am I to begrudge an employee if they can find a better opportunity elsewhere? And with clients, there are so many of them that I really feel like, in an urban setting, “Does this really matter?”” And they were asking, “When I'm thinking ahead as a practice owner, am I crazy for thinking about disregarding non-competes from my contracts? What are your guys' takes on non-competes?” And I just was like, “Oh yeah, let's talk about this one.”

Andrew Roark:
Yeah, I think this is good. I think non-competes are an area where there are some significant changes that are taking place.

Stephanie Goss:
Yes.

Andrew Roark:
It is a big deal. I was talking to my friend, Dr. Lance Roasa, who's a veterinarian and also a lawyer, and he helps veterinarians with contracts. He's an awesome guy. I've interviewed him a couple times on the Cone of Shame podcast and this was something that he really teed off on as far as a hot area where change is really happening. So I think that that's really cool. So I'm happy to talk about this and where I think it's going and where it seems to be going. And then also I think we could talk in a little bit broader context about contracts in general. I think that that's a fun conversation.

Stephanie Goss:
Sure. Okay. I'm up for it. Like I said, we were having some soapboxy kind of conversation about this last week, so I'm excited. I'm here for it.

Andrew Roark:
Yeah. So before we start talking about non-competes, we need to talk about what the importance of the contract is. And I think a lot of people hand wave over this and they say, “Well, you get a contract. That's just what you do.” And I think there's a couple things about contracts that people maybe don't really think about or don't really understand. And so I will share with you through a school of hard knocks a couple things I have learned about contracts. I am a big believer in the idea that a contract is probably only worth the reputation of the two people who sign it. I really am. I think a lot of people, because they want to believe they have control in this world, believe that they're going to get a contract and that is what will be, and what is written in that contract is chiseled in stone.
And I can tell you, having navigated more of the legal system than I ever wanted to, that's not true. And I wish that it was, but it's not. You say, “Well, this is written down. How could that not be held accountable?” The two things that I would say to people is some people just flat out lie. You could say, “Well, they didn't do this.” And they'd say, “Yes, I did.” And you're like, “No, you didn't.” And unless you can prove that they did not do something, they can say that they did. And it is wildly frustrating, but there's nothing you can do about it. And I think that happens a lot. And they can also make up things and say that you did them. Unless you can prove that you didn't do the made up things that they said, they can muddy the waters.
Oh boy, that's a story for another day. But anyway, it is just a truth about our legal system is I always naively just kind of assume that people would be honest and what was written down would be enforced. And I can tell you, having played the game for a little bit, it ain't that way. The other thing is that enforcing contracts is really expensive. I mean, it is really expensive. Because you're hiring a lawyer at hundreds of dollars an hour to wade into trying to enforce this contract. And if you are going up against, especially a big company, one of my friends, as he put it, was, “Andy, you're fighting a grizzly bear with a pocket knife and it's not going to end well.”

Stephanie Goss:
That's a good analogy.

Andrew Roark:
It's a good analogy. You go, “Oh, I'm going to go up against the legal department of this massive corporation with my buddy Earl, the local attorney. This is going to go well.” Nope, nope. So anyway, those are hard lessons about contracts that I have learned, and I should have given a trigger warning before I laid that down because some people just really don't want to hear that, I'll just tell you that. That's the American legal system in a lot of ways. And I can't speak to the Canadian legal system, but that's it. I will also say, just as we talk about contracts, that suing people is a terrible, horrible experience that you really, really, really want to avoid. You want to avoid suing people as much as you want to avoid being sued. The whole thing is awful. And so when you start thinking about contracts, start thinking about, “What does this really mean and what is really going to be enforceable? And what am I actually going to do if this person violates these things? What are we going to actually do?”
And I'll save you a lot of turmoil that I went through over the years but the ultimate outcome is it's all relationships. It's all relationships and clear expectations. And so I'm not saying I don't use contracts, of course I do, but I think have a pretty healthy view of them, which is, I really don't want to use this. I think the big things that I want here are clear expectations about what I expect and what you can expect from me, and that is the most valuable part of the contract. And then just a focus on a relationship, which means I want to be a good, trustworthy, honest person and I want you to be a good, trustworthy, honest person. And we're going to communicate as we go along as if we didn't have a contract and we just had to work it out on good faith. And that's my best advice on contracts. And so as I start to lay that out and say, “This is what I've learned about contracts,” you can already probably see where I'm starting to go as far as non-competes and things like that.

Stephanie Goss:
Yes. And the other thing that I would add is I think it's funny, I remember really fairly early on in my career as a manager, I remember being asked to sign a contract. And I remember talking about it with my colleagues. And at the time, managers didn't have contracts, it was just doctors and everybody thought I was crazy. But I'll tell you the secret from a headspace perspective, because I think you're spot on, Andy. And for me, maybe I was just young enough and dumb enough and naive enough to not be worried about the legal perspective of it. And what I mean by that is I understood the gravity and I understood, “This is a legally binding document and I'm signing the thing.” I got all of that. And to your point, for me it was about spelling out the plan, spelling out the expectations on both sides.
And I was looking at it from a headspace perspective of, “Am I going to feel good going to sleep at night if I live up to the terms that I'm agreeing to? And on the flip side of that, if the other person in this relationship or persons in this relationship don't live up to their side of the bargain…?” I had a mentor explain it to me, and this was the light bulb moment, they were like, “You should have no qualms about walking away if you've lived up to your side of the bargain and they don't.” That's how I sleep easy at night. And that was really from a headspace perspective was the light bulb for me because it shifted my mindset when it came to the contract into the space that I think you're talking about, Andy, which is, “What's the point? What's the why behind it?”
Well, for me, on a personal level, I'm a big advocate for it, even for our team members, which a lot of managers look at me like I've completely lost my mind when I bring that up. But it's about clear expectations. It's about knowing what I want, what I can expect on both sides, and what my employer, in this case, generally can expect from me as an employee and what I can expect to receive from them.

Andrew Roark:
It should be a two-way document like that. That is the why of the contract for me. Now, additional point I want to add, as you say that, it is amazing to me how many people sign contracts without reading them.

Stephanie Goss:
Oh my gosh, yes.

Andrew Roark:
That's bonkers.

Stephanie Goss:
That's frightening.

Andrew Roark:
And I have seen it so many times and in big companies, I've been like, “You guys signed this thing, you signed this?” And don't be that person. Do not be that person. When you ask Andy Roark for advice and I look at it and go, “You signed this?” It's important, it's important if you're going to sign it… Especially if you're going to sign something that someone else wrote, you better really just read it and know what's in it.

Stephanie Goss:
Yes.

Andrew Roark:
And so that's the other part. The last thing I'll say about contracts, and this is sort of where I came to in my career a while back with contracts. And so this is what I aspire to, and I think that our writer will probably like this. I've talked on the podcast a number of times about Rawls' Veil of Ignorance and Rawls' Veil of Ignorance is this sort of mental exercise where you look at a system and you say, “If I was dropped into a different chair at the table than the one I'm at now, would I be okay with that? Would I feel like the arrangement was fair?” I'm not saying, “Would I be happy necessarily but would I feel like it was fair?” And that's Rawls' Veil of Ignorance. So I run Uncharted and we hire presenters and speakers and I have worked as a presenter and speaker for years and years, like 15 years now I've done this.
And it's interesting to be on the other side of the table because I'm looking at the event part and saying, “Boy, we got to pay the hotel and we got catering, all these things and blah, blah, blah.” And it has always been important to me to put forward a contract that I would think was fair if I was a speaker. That doesn't mean I would take it. I might say, “This is not enough money for me,” or blah blah, blah, blah, but I would feel that it was fair and I would not feel that it was a manipulative contract or it was trying to take more than what I thought was a fair agreement. And so I really tried to work it backwards and forwards to say, “Do I feel good about this as a person writing the contract? Would I feel that this was fair if I was signing the contract?”
And again, this is sort of a philosophical point, but I really think that that's what we should aspire to. I think that's part of being a good, honest, ethical person and a good employer is to say, “I want an agreement that works for me and I believe it's going to work for them and we can talk back and forth about it, but for the most part, I want this to be something that if I was on the other side, I would say, “Okay, I understand why you're asking for what you're asking for.” And we can decide whether it's 14 days of vacation or 10 or 20, but the basic idea being, “Okay, there's a limited amount of vacation and it's clearly stated and I'm on board with that.”

Stephanie Goss:
Yeah, I'm so glad you brought up the point about the fairness and looking at it from through Rawls' Veil of Ignorance, but also the perspective of, “Did you read this because I really can't believe you signed this?” From a headspace perspective, that's really important to me because if you read it and it seems incredulous, you should probably ask. You know what I mean? You should listen to the Spidey senses. And I speak not so much from personal experience, but I've had multiple conversations with young veterinarians and I know, Lance, having worked with as many vets as he has over the years, has heard this time and time again. To your point, people can ask for whatever they want. So as a practice owner, there's nothing to stop me from throwing out a contract that says you have to give me 12 months notice as a veterinarian because maybe in a perfect world, that's what I would want.
On the flip side of that, that's where I would be like from a headspace perspective, “Oh buddy, if you don't read that and you don't look at that and go, “I'm not signing this,” I'm giving you permission, look at that and say, “I'm not signing this,” because that's nuts.” That's where from a headspace perspective, we have to think about it from the perspective of a relationship. And sometimes relationships work great and everything works out really well and sometimes they don't. And so not to assume bad intent because we want to assume good intent, and so when we're framing it on both sides, we should think about it through the lens of good intent. And we should also think about it from the lens of, “This is a relationship and what happens if it doesn't work out? What does that look like?”
And it amazes me how often… And unfortunately this veterinarian who wrote into us found themselves in that predicament where they were trying to get out of their contract and they then went back and read their contract and sure enough, there was a clause in there that bit them in the butt in a big way. And they were like, “Well, never going to do that again,” which is where this came from. And it never ceases to amaze me how often I see that being the case for veterinarians and it makes me really sad.

Andrew Roark:
Well, the notice of leave part is one of the three big bugaboos that I see in contracts with veterinarians, and it's a really wonderful example of that Rawls' Veil Of Ignorance. And I say this because I talk to friends who are practice owners and they say, “Well, if you tell me you're leaving, Associate Vet Andy, it's going to take me four months to get another doctor given the hiring climate right now. And so I need you to give me four to six months notice so that I can find another veterinarian and my business is not damaged and I don't have to worry about having to lay off support staff because we don't have enough doctors,” and blah blah. And they have a very reasonable case from their side of the table on why they would like six months of notice.
And that's why the Rawls' Veil is really good because I said, “All right, clear your mind for a second. Now you come sit on my side of the table and you're an associate vet who's unhappy here or whose spouse is trying to leave. Are you going to stick around for six months after realizing that you need to go? Would you be willing to live apart from your spouse because they got a new job and you have to live alone for six months and pay two rents or a rent and a mortgage? Come on.” That's ridiculous if you put yourself on the other side of the table. And again, I'm not trying to vilify the owners, I understand exactly why they feel the way they do, but part of a good contract is to say, “I see this. Surely the associate vet recognizes, hopefully they recognize, why I need some runway. I need to know a bit ahead of time.”
And I don't know if people understand or not, I mean I hope that they do. So there is a reasonable amount of time to say, “Hey, go find yourself another vet and I want to give you some time and support you while you do that. And at the same time, I need to be free to go on and live my life after I decide that I need to go somewhere else.” And that seems very reasonable as well. So that's a big one. And again, I've seen so many doctors that when they recognize how much notice they're supposed to give is when they decided to leave and they're like, “Oh, 90 days? I'm supposed to do 90 days?” I'm like, “Yeah, that's what you agreed to.” So there's that. The other two areas I always throw out when I say to people, “You didn't read your contract?” The non-competes are a big one.
And I feel like the vet schools have done a good job where there's been a lot of business education in vet schools in a way there did not used to be. So I feel like this is less common, but boy, I remember 10, 12, 15 years ago, there were a lot of doctors who looked around and they were like, “I'm not happy here. I'm going to go work across the street.” And they looked down and it was like, “Oh no, I signed a 30 mile. I am not able to work in this town. My 30 miles runs out in the farmland outside of town, which means basically I have to leave town because it didn't work at this practice.” And I go, “Oh boy, that's a big one.”
The last one is negative accrual, which is again, it was phrased in a way that people didn't really recognize what it meant. And so what happened was the doctors would say, “Oh, I get paid on production, that's great. Let's go.” And what they didn't realize is that if they didn't hit their production numbers, they had to give back the amount… Oh, not really. But the amount that they came up short would be held against them as opposed to resetting and letting them try again next month. And so they would come in as a new graduate into a new system and they wouldn't have cases lined up and they wouldn't come anywhere close to hitting their assigned number.
And then they're so deep in the hole that when they are a good productive veterinarian, they're still buried underneath the deficit they had when they weren't fast and they weren't seeing cases. And again, I also understand from the practice owner's standpoint, when they say, “Well, I'm supposed to pay this person and if they're not generating revenue, then I shouldn't have to pay.” I'm like, “I get it kind of,” but also put yourself in the position of the doctor and you go, “This is not going to fly.”

Stephanie Goss:
It's funny because I can absolutely see both sides on all three of those points. The non-compete, the negative accrual, the leave, I can see arguments on both sides like you laid out. And so for me now where I'm at in my career, I look at it and I think for a lot of practices, particularly I would say that the reasoning behind it is different I think in corporate practice structure often from private practice structure, but ultimately I feel like there's a root of commonality between the two. And that is, “We don't like conflict.” And really for a lot of people, the contract serves to avoid communicating about those hard things. And so the negative accrual often is one of those things. And it's funny because I worked in a practice that paid their doctors solely on production, private practice, and we had negative accrual and I didn't think twice about it for a really, really long time.
And then I had an associate who was on the other side of the table and was asking some really great questions that really made me think about it. And what I realized is that that is a perfect illustration for we choose to have the contracts because we're afraid of the communication that has to come once someone isn't doing the thing that they're supposed to be doing, right? They're not upholding their end of the bargain. And from a headspace perspective, I think it helps get us into the place where we can assume good intent on both sides because if we look at it through the lens of, “Oh, we might be trying to have this document that will help us avoid some of this conflict,” it becomes easier to I think assume that good intent. And what I would say is, as leaders, whether you're a manager, practice owner or director, it's bullshit. You have to communicate.
So now my point of view has changed radically. I don't want to have to have a contract that has a non-compete or has a negative accrual because realistically, I really truly believe I'm not doing my job as a manager if I can't have the hard conversation with an associate, whether they're a new grad or a tenured doctor like yourself who's been practicing for years. If there's a change in your production level over time and you're not producing to pay yourself, that's a conversation that I should be able to have. I shouldn't have to say, “Your contract says this is what you're going to do, so this is the lever that I'm going to pull to get you to do what I want.” I should be able to take accountability for that and I should be able to have that hard conversation.

Andrew Roark:
Well, I love that you say that. It is amazing how many policies and contractual pieces are put into place to avoid having to actually manage people. And there's this fairytale of, “If you set it up the right way, you don't have to manage people.” That's the whole pro-sol mentality for doctors is, “We pay them, they have a base salary and then we pay them on production, and then that way they're going to work hard and they're going to work up cases and I don't have to talk to them about their medical skills and what they're recommending in the rooms because it all takes care of itself. And I guess-“

Stephanie Goss:
“Because if they want to get paid, they're going to do the things that I want them to do.”

Andrew Roark:
Exactly. And you go, “That is not true. You still have to manage those people,” but it's amazing how much that's set up to be that way. One of the things I want to say about contracts, and you propped this into my mind, one of the absolute critical things to remember with contracts is there is no right or wrong here. A lot of people are like, “Okay, Andy, tell me what to ask for my contract and I'll go and get it. So negative accrual, out. Six months of notice, out, blah, blah.” The truth is none of those things are chiseled in stone. My thing is not to say to you, “Don't take a negative accrual contract.” It's not. It's to say, “You need to understand what the deal is and then you need to decide what is right for you and your family.”
I don't think my employer would mind me saying this at the vet clinic, but I work on a straight production at the vet clinic where I work and I love it and I do not expect any sort of a base salary or anything like that because I have great schedule flexibility and I travel and I do lots of other things. And the deal with them was, “Hey, let me come and work and I'll have sort of a flexible schedule, but I want to be here. I want to see cases and then we'll do a production deal and that's all you have to pay me. And that way if I travel, you're not losing any money,” whatever. It works great for us and for where I am in my career. So I would not knock anybody that. If a vet understands what negative accrual is and says, “I understand why you want this, and so I'm going to agree to it,” I'm fine with that. I really am, as long as everybody's eyes' wide open about what the deal is and why it is.
And I'm trying to think of a reason an employer would want that. Maybe the vet is pushing for a really high base salary and the employer's like, “I don't know that you can make this.” And so they say, “Well, we'll do a negative accrual then.” Maybe that's a compromise that works. And so if so, I don't want people to say, “Oh, she said the words negative accrual and Andy says that's horrible.” It's not. That's not how life works. It really is about your specific relationship and what you get. And so the last part I want to put forward sort of in headspace on contracts is this. And so I want you to hear this because this is really important. If you go into a contract trying to get ahead, you are limiting probably the outcome that you can achieve.
It's like the prisoner's dilemma. So the prisoner's dilemma is this psychology game where we set it up and the game can be a little bit complex, but basically the idea with the prisoner's dilemma is you have two players in this game and the best outcome for you in the short term is to try to screw over the other person. And if you screw over the other person, then you will get the better outcome. However, if both people try to screw each other over, you get the worst outcome. And so in the short term, the best thing is for you to screw the other person over and then not to screw you over. If you play the game multiple times in an ongoing way, you very quickly realize that the best possible outcome is collaboration. Don't screw them over and they don't screw you over and we get the second-best outcome again and again and again and again and again and again. Otherwise, you'll screw them one time and then they'll try to screw you and then you both end up screwing each other and you get the worst outcome again and again and again.
And I see contracts like that. So I hope that's not too far of a stretch, but basically the idea is if you go into it going, “Aha, I'm going to stick this associate vet I'm hiring,” or you're the associate vet and you're like, “I'm going to ask for this ridiculous thing and force it…” Like, “I'm going to ask for a salary that's way beyond what I can actually earn or justify and I'm going to use hardball tactics, I'm going to get it,” you might get it, but you're going to have a short tenure at that practice and it's not going to be fun and you're going to feel less than and you're going to have to sit to a lot of conversations about how you're not producing what your salary warrants and then ultimately you're going to leave and that's going to be how it's going to go.
And you're probably not going to be super popular when you go. And I say that to both sides. I really believe going into contracts, the best thing is to treat this like a relationship. It really is. “These are my needs, these are your needs. I want you to understand where I'm coming from and why I'm coming from here. I want to understand where you're coming from, what's important to you. Let's make this thing in a way that we both get what we need and then let's continue to communicate on an ongoing basis to make those adjustments.” And that is the strategy I think for having a healthy, happy employment.

Stephanie Goss:
Yeah, I love it. How do you feel about taking a break here?

Andrew Roark:
Yeah, let's take a break.

Stephanie Goss:
Hey, friends, I just wanted to talk for a quick second about the maths with you all because I've been thinking a lot about the workshops and normally here's where we tell you what's coming up and we've got some great stuff happening so you're going to want to head to unchartedvet.com/events and check out the upcoming calendar but I want to talk about maths because if you are not already an Uncharted member, you can attend any one of our workshops and pay $99 a piece. Most of them are just $99. You can do it as a one-off, great and fine. However, that adds up really quick. And if you do the monthly workshop with us, and I've seen some of you there as repeat customers, which is amazing, but you could spend almost $1,200 over the course of the year doing workshops with us, or you could pay $699 and get a 12-month membership, which means you get all of the workshops that we do at no extra charge.
You also get access to our amazing conversation in the community, our community members, and all of our community resources. And it is hopping over there. We've got conversation 24/7, we have got activities, we've got book club. We're writing our handbooks together in Handbook Helper Group. This year we are talking about development and leadership growth, doing our development pathway this year. We are doing hallway conversations where we're talking about topics. These are sessions that are community led, community driven. It is topics about things that are going on in your practice that you want to talk about with your peers. All of that is happening and it's all included for your $699 membership. So simple m, do you pay almost $1200 for the year or do you pay $699?
If you're not currently a member, you should head over to the website and use this argument to convince your boss. “Hey, boss, I need to be a part of this amazing community because Stephanie told me and because she's telling you that you will save money.” Hopefully that works, but I couldn't resist. I hope to see you at our upcoming workshops. Again unchartedvet.com/events for everything that's coming. And now back to the podcast.

Andrew Roark:
All right, so let's get into the actual question that we were asked.

Stephanie Goss:
Okay.

Andrew Roark:
Which is basically, “I'm thinking about not having a non-compete. I am sensing that there may be a falling out of favor. Am I about to make a really terrible decision decision?”

Stephanie Goss:
Sure.

Andrew Roark:
Exactly. All right, cool. The way I like to look at this is let's look at the non-compete real fast and let's just look at the pros and the cons. So we'll start with that. I think that people in the last… Before we took a break, I said, “We need to be really honest about what do we want and need.” And if you're like, “Hey, negative accrual works for me and I understand why you want it,” then you can do that. I think non-competes can be that way too. The question for me has to be, “Why do you, practice, want me to sign this non-compete? What do you care about?”
And if they say, “Well, I don't want you to work for anybody else in town,” I would say, “Hey, you're going to need to go jump in the lake.” That's ridiculous because I would say, “I'm not interested in signing a contract that's going to make it so that I have to move away if this doesn't work out.” I'm not interested in signing that. If you're thinking about adding a non-compete, what do you care about? And I think most people when they stop and, again Rawls' Veil Of Ignorance, and they put themselves in the position of their doctor, they go, “Okay, my real fear is that they're going to go literally set up a practice across the street,” or, “They're going to get this clientele and they're going to go to our main competitor who we have a Hatfield-McCoy's feud with, and they're going to take our clients and go work there.”
And so that's why people put it forward. The other reason that a lot of businesses put it forward, just to be clear and candid about what's out there, if you're running a practice like you might sell your practice, a lot of the big buyers of practices really like non-competes. They want to have the doctors locked in there in a way that makes it hard for the doctors to leave if the sale goes through. And so what their worry is that the practice gets bought and the doctors all just flee, and now they've bought this practice, they don't have any doctors in it, and so they really like non-competes. And so there is some stability that comes from that, and there's a lot of places that want that. And so just talking about why it happens, I think there are the big reasons. Are there other reasons that you have, Stephanie?

Stephanie Goss:
I could see both of those for sure. The other way I guess that I've seen the non-compete use that makes some valid sense to me is the opening your own practice within a certain radius of the existing practice, because that feels radically different from the seat of the business owner. My associate not being a fit for my practice or being unhappy and going to work at another practice across town feels very different than my associate being mentored by me and my team and then going and opening their own practice right across the street. Those two things feel very different. And so I could totally see something in there from that perspective. But again, when you use Rawls' Veil, is it enough to justify having it in the contract? I don't know.

Andrew Roark:
Yeah, I don't know. Yeah, exactly. A lot of it was-

Stephanie Goss:
But I get wanting to ask for that.

Andrew Roark:
Of course.

Stephanie Goss:
For sure.

Andrew Roark:
And a lot of it is following suit forever. If you were an employer, you put a non-compete in, that's what you did. And so there was great pressure of, “This is how it's done and this is how it works.” So anyway, those are the reasons that I could come up with. “I don't want you to go work for a mega competitor,” “I don't want you to go and start up your own place and take half of our clients away from us. And again, can you accomplish some of that, “Don't take half of our clients away,” with non-solicitation agreements? I think you can to some degree. I really do. And then if you plan to sell the business, a buyer likes to know that doctors are locked in there. It gives them some security. So I get why that happens. What's funny is I start talking about training up a doctor and introducing them to your clients and they grow this clientele and then they leave and they work somewhere else.
You and I did a podcast back in April. It was the April 26th Uncharted. And it was about the technician that got trained and licensed and then left the practice after the practice had paid for licensing. And boy, this feels really similar. It really is that. “I'm investing into this person and putting all of this time and energy into them. And then what if they leave?” And you go, “Okay, I get it.” I think it hits very much on that same scarcity mentality of investing and then having someone go away and we don't like that. So anyway, I'll put this forward as reasons you would have a non-compete. I think the reasons that not have a non-compete, some of it would be, if you do the Rawls' Veil Of Ignorance and say, “I think most of us, we recognize that sometimes things don't work out.”
Someone comes and they work and then it doesn't work and they leave. And I would not feel good with saying to someone, “You have to leave town. You can't work in this town, so sit on your hands for two years.” I think morally I would sort of struggle with that. It doesn't feel like an equitable thing to do. So that's a big part of it. The other thing is that the winds are changing. The law is changing. In human medicine and in the legal profession, non-competes are now done. They're not allowed. And the rationale that was put forward to break that and make those things illegal is we should not have a system where doctors have a relationship with patients and then that patient-doctor relationship gets broken because the doctor has to leave because of a non-compete. We should keep that patient doctor relationship intact. The legal counsel-client relationship, same thing. That should not get broken if that person goes to work on their own or something else.
And so in order to protect those relationships, the non-competes have been struck down. I fully expect that veterinary medicine will probably fall into that same category for those same reasons. And we're already seeing that in a number of different states. There's a lot of pushback on this, right?

Stephanie Goss:
Yeah, it's been interesting to see the transition here in Washington, because they're not enforceable. And so it's been interesting to see the transition, especially working in corporate medicine. And there's often the perception of, “Well, every corporate contract has a non-compete,” and it's not true.

Andrew Roark:
Yes, I think that's important.

Stephanie Goss:
Like you said, we're already seeing it and I would expect that we continue to see it more and more and more. And from this, looking at the pros of why would you not have a non-compete, I think it's a lot healthier in so many ways. And I love the point about human medicine and legal profession because I think there's legitimacy to that. If you have a client or a patient that's particularly bonded to one of your veterinarians and that veterinarian is deeply unhappy or there's circumstances that make them want to leave their practice or they want to open their own practice or whatever it is, mentally, ethically, I guess my personal take is, “Do I really want to get in the way of that?” Leaning into your point about human medicine, if they have a relationship, go with them and I think it goes back to what you said about the scarcity mentality.
I think so many of us are afraid of losing clients, and we think about the one client, but we don't just think about the one client. We can't stop ourselves at the one client. We go from the one client to living in the forest in a cardboard box. We can't. It's just human nature. We can't stop ourselves from catastrophizing that. And so on the practice owner, the practice leader side of it, we go from that, “Well, maybe a few clients or their really loyal clients will follow them.” Well, that should be good. It should be good that they worked in my practice and they built a loyal client base who wants to stay with them because I should look at it from the perspective of, “I shouldn't be in a place where that change should make or break my business.” And I think that scarcity mentality is something that is really hard for a lot of us, myself included. It took me a really long time to get to this place. It's really hard for us to wrap our brains around because it's scary.

Andrew Roark:
Yeah, I agree with that. There's just a couple things that are just sort of absurd in non-competes that I see that people haven't really questioned for a while. Some of it was the distance in the non-competes. Like, look, if somebody's willing to drive 10 miles to see a veterinarian, for God's sakes, let them drive that far. I mean, at that point, you're getting into a relationship that that person really cares a lot about, right? And I have seen that. I've seen people put these huge non-competes out there and you go, “This is ridiculous. No one's going to take your clients at scale at anything beyond a couple of miles.” And then the other part is, and this has always kind of baffled my mind, so here's the thing, you're a veterinarian and you're going in to take a job and you're like, “I've never worked here before and I don't know anybody.”
And they're like, “Here's a one-year contract, sign this non-compete.” And you're like, “How fast do you think I'm going to meet people?” And I get that the idea is introducing it early on but here's the thing too, there's a very good chance that I'm going to come here for one year, it's not going to be a great fit, and that I'm going to leave. We don't like to believe it… I think a huge percentage of relationship, especially with brand new veterinarians, that first year in practice, they're going to leave after a year. Why in the world are you making it so they can't stay in town? It doesn't make any sense. Now, I understand when people are like, “Oh, this person's been here 10 years and they have this huge clientele,” and blah, blah, blah. That feels different. I think there's different reasons there to say, “Well, this person at this point has kind of earned these relationships,” and so on and so forth.
But anyway, that was a thing as a… I remember being a brand new graduate or even not a brand new graduate, but as someone who would move to an area and they're like, “Here's the contract. Also if this doesn't work out, you can't work anywhere near here for two years.” And I'm like, “That's ridiculous. If we get six months into this and it's not working, I shouldn't be blown up for two years. That's not right.” So anyway, I've seen a lot of that stuff.

Stephanie Goss:
And I think on the flip side for a second, you just brought up a really, really good point. So I think there's validity for not having a non-compete. From the perspective of the associate, to your point, if it doesn't work out for me, I should not be restricted for two years from moving on. That is total BS. And this is where it's about, “We don't want to communicate,” coming into play. On the flip side, as a practice owner or practice manager, why, for the love of all that is holy, why would I want to trap an employee into a contract with me where if they are miserable, they might stay just to live out their crappy contract that I gave them in the first place because they're afraid of getting sued? I don't want them to be in my practice making my life and everybody else in the practice's lives miserable for two years because they're afraid of that.
Why would I do that to myself? And yet I see it time in time again from practice owners because they're thinking about leveraging it in the positive to protect themselves. But realistically, it, also to your point, opens you up just as often to that from the negative side because it is a relationship and sometimes it works and sometimes it doesn't. And we have to think about that because we are also trapping ourselves when we use the non-compete in that regard, especially when it comes to those leave notices or the, “Don't go to another practice within a such and such certain distance.”

Andrew Roark:
It can feel punitive rather than strategic meaning, “Oh, you want to leave? I am going to shut you down. I am going to punish you. I'm going to give you a two-year headache because you left.” And that's not a good place to build a reputation. The last part, when you factor this in, is there are more and more practice groups that are advertising no non-competes. They are like, “We don't believe in non-competes and we are not doing it.” And you can take them at their word and go, “Wow, some people are really great.” Or you can be more cynical and say, “Ooh, that's a hiring advantage. They've figured out that they're probably not going to be able to keep using these anyway. And so they're casting them down and trying to use that as a strategic advantage in hiring.”
But that said, I think more and more doctors are going to hear about places that don't need non-competes or require non-competes. And so I don't know how widespread that's going to be, but I do think it's probably going to happen. And so anyway, all that around, so takeaways from me and then you can decide if you want to jump in on this, these working relationships are relationships. Everybody should be open about what they're offering and what they need. And the plan should be that the contract is part of the ongoing conversation of us working together, and they should put that down. I think non-competes are falling out of favor across the country. I don't know if that will be a complete sweeping change in the next 10 years or if that will be spotty, but they are starting to fall out of favor.
I think your options as an employer are either to say, “We are not going to use them and we're going to focus instead on just trying to maintain good relationships. And we understand that there's some risk, just like we understand there's a risk of us training our staff and then having them leave to go work somewhere else. It's just a risk that we incur.” I think that's probably the healthiest way to go. The other alternative would be to say, “Hey, I have these very specific concerns and this is kind of what I need to feel safe.” And I would say you should dig into what those specific concerns are and communicate upfront.
I mean, there is a way to say, “We're going to have non-compete. It does not kick in until you've worked here for three years. And at that point, if you're here for three years, then it's going to be a fairly limited range, and it's for these really important reasons.” I think you can talk about that just like we talked about the other parts of the contract and say, “If you have a good why and you're willing to make concessions to get the other person to agree to that, and you can articulate what your needs are, if you're okay with it and the vet's okay with it and everybody feels good, then go with it.”

Stephanie Goss:
Yeah. Yeah. I love it. And the only other thing that I would add to your point about it's a relationship and the contract helps define that relationship is on both sides. Especially knowing that this ask came to us from a potential practice owner, I'm going to throw out there, “Don't forget that needs change and they change on both sides.” And so the other piece of this that often doesn't get talked about, but I think that goes along with the ideas of non-competes and negative accrual and stuff like that, that is the winds of favor are shifting, is the perpetual contracts where it's like, “I don't review your contract again until you bring it up.” And as a manager, oh man, so much anxiety, especially early on in my career when one of my associate doctors would be like, “I would like to discuss my contract,” because it felt very negative.
It felt like, “Oh gosh, they're going to ask for some big change and it's going to be the end of the world.” The reality is we're humans in a relationship on both sides, and my needs change as an associate in the practice and my needs as a practice owner change, and we should have a system and a structure. Again, it goes back to the contract can't be the thing that you hide behind because you're afraid of the hard conversations. It has to be set up so that both people in the relationship have the ability to communicate their needs and make it work for them together. And to your point, Andy, sometimes we are in different corners. How do we bridge that gap to come together?
And so I think that's the other piece as a practice owner is if you're doing that to your team, if you're just like, “We're going to do your contract and then we're not going to review it again until you bring it up,” that would definitely be something that I would suggest. Take the stress and anxiety out of it and make a system for it so everybody knows, that it's communicated upfront like, “This is what we're going to do, this is how we're going to do it, this is when we're going to do it.” Put it on the calendar and then actually follow through.

Andrew Roark:
No, I agree.

Stephanie Goss:
Cool, cool.

Andrew Roark:
Well, I mean that's what I got. It's not the firm, “This is how you do it,” answer, but hopefully it's a good way of thinking about contracts in general. Start with the end in mind. What do we want to accomplish? Then going into the relationship, talking about needs that I have, needs the other side has, and then trying to come up with something that works for everybody. Know that non-competes seem to be losing favor. Know that there's other companies that are going without them and using that as a recruiting tool. Just adjust and react appropriately.

Stephanie Goss:
This is so fun. Take care, everybody. Have a fantastic week.

Andrew Roark:
Thanks, everybody. Take care.

Stephanie Goss:
Well, gang, that's a wrap on another episode of the podcast, and as always, this was so fun to dive into the mailbag and answer this question, and I would really love to see more things like this come through the mailbag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mailbag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care, everybody, and have a great week. We'll see you again next time.

When Non-Veterinarians Disagree with Veterinarians on Medicine

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are in the mailbag to take on a question from a practice owner. One of their managers is disagreeing with one of the associate veterinarians and there are some hurt feelings and upset on both sides. There also happen to be good points from both the manager and the doctor involved in this instance and this practice owner needs some help keeping the peace! Let's get into this…

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

Do you have something that you would love Andy and Stephanie to role-play on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag!

We want to hear about your challenges and would love to feature your scenario on the podcast.

Submit it here: unchartedvet.com/mailbag

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Episode Transcript

Stephanie Goss:
Hey everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, we are tackling an issue that Andy and I had a really good time talking through. We have a friend who is a practice owner and they are struggling with their practice manager, having some disagreements with some of the doctors over some of the decisions that they're making on the floor.
There are good points on both sides of this situation and argument, and this practice owner needs help figuring out how to keep the peace. This was a fun one. Let's get into it.

Meg:
And now the Uncharted podcast.

Andy Roark:
Hey, and we are back. It's me, Dr. Andy Roark and the one and only Stephanie. Before you accuse me, take a look at yourself, Goss. Oh man.

Stephanie Goss:
How's it going, Andy Roark?

Andy Roark:
Oh, it's good. It's good. I took my daughter to a 5K fun run on Saturday, and our friend Tyler Grogan, had signed us up to go. And so I was like, “Okay, Tyler's going and some of the other people in the Uncharted team are going. And I was like, I'm, I'm going to go as well.” And I was going to take Hannah, who's my 11-year-old, and it would be sort of her first cross country. She's never ran more than maybe two miles I think, something like that.
So my expectation was we were going to get there and we were just going to kind of run-walk, and it was about being together. So we would do that. And so we go to this 5K, and it's put on by the local animal shelter. And so there are dogs everywhere because they were like, “Bring your dogs.” And I'm like, “I like dogs, I love dogs, I love dogs, I love pet owners.”

Stephanie Goss:
This will be fun.

Andy Roark:
This will be great. And then I got there. And I was like, “This a terrible idea.” It's a terrible idea to bring together literally hundreds of people with the objective of running 3.2 miles and then be like, ‘Bring your dogs.'” And so there we are. And they're like, “Thank God they didn't have a starting line.” But a couple things came into my mind.
Every time I go to a place where there's people and dogs, I am reminded of how pet owners tell themselves stories about their dogs and just hold onto those stories despite all evidence.

Stephanie Goss:
Sure.

Andy Roark:
There was the dog having a full on panic attack, and people were like, “Look at him. He loves coming to things like this.” And I'm like, “That dog, his eyes, bulging out of head just trembling full body shakes, nails dug into the ground.” And they're like, “He's such a social dog.”
And I'm like, “He's too scared to move. What are you doing?” Before they started, they were like, “If you plan to run fast, come to this end of the group.” And all these people just moved down there with their chihuahuas on leashes. And I'm like, “What? This lady with an English bulldog?” And I'm just like, again, the stories that they tell themselves about their pets is amazing to me. So anyway, so they all do it and finally they're like, “They don't have a starting gun, thank God.” But they're like, ‘Ready, set, go.'” And hundreds of people take off running at the same time. And as you can imagine, it's pandemonium. And there's this woman with this big pit bull running up out of ahead of me and Hannah. And the pit bull is morbidly obese. It's a BCS 11 of nine, and then it runs about a hundred yards.
And then stop. It's like, I'm done and just sits down and the lady runs right into it. She goes down.

Stephanie Goss:
Oh no.

Andy Roark:
And the people behind her go down and then all the dogs around them are like, what are you guys doing? And they come pulling over and now these leashes are pulled out like trip wires.

Stephanie Goss:
Oh no.

Andy Roark:
And there's like retractable leashes everywhere. It's everything that's completely horrible that you can ima … It all happened. And I was like, “Hannah, we're going over.” And we lept over. Did not stop to help. Just so you know, I'm kind of like lady, you know thy self, know thy dog. And you didn't. And so I get it. She was in the middle of hundreds of other people. And again, it's a race. I told myself that stopping would have caused more problems.

Stephanie Goss:
So you were also telling yourself stories in your head.

Andy Roark:
Exactly right. Survival stories, Stephanie Goss. Stories about-

Stephanie Goss:
Someone else is going to help that woman. It's fine.

Andy Roark:
She was shielded by the dog, really it was like-

Stephanie Goss:
I'm sure there's another vet in the crowd who could have made sure the dog was okay.

Andy Roark:
I'm sorry. She didn't need a vet. And the pit bull was fine because she was big and he just laid down. And no one's stepping on that dog, I'll tell you that. That lady is to fend for herself. But that dog was fine.
We got like two miles into the run, and there's this lady sitting on a bench and she's holding this Chihuahua and he's 100% asleep just like nose under her chin, you know what I mean? She's holding him like a baby and his legs are up in the air and we go jogging by, and my daughter and I look at her and she looks at us and she goes, “He's done.” And I'm like, okay, I love it. But she says, “He's done.” That's what I wanted to be. We're two miles into that. I was like, I would like to lay down and just be done, but everyone …
So anyway, it was, again, I loved it. Wonderful time with my daughter. I still love pet owners, I still love pets. I'm just not a hundred percent bought into hundreds of pet owners and pets together doing a thing at the same time.

Stephanie Goss:
Oh, that's fantastic. But it's for charity.

Andy Roark:
Yeah.

Stephanie Goss:
That's a real good cause.

Andy Roark:
Felt very good about supporting. I felt very good about supporting. And it really was fun. And so that was that.

Stephanie Goss:
Oh gosh, Tyler's take on the event was radically different than yours.

Andy Roark:
Oh, well, see, she just walked.

Stephanie Goss:
I don't know that there was ever running in the idea, although I could see Tyler being a runner, but it was like, we'll do this fun thing together as a team and we'll talk and just meet, make our way through and it'll be bonding.

Andy Roark:
I showed up with my itty bitty booty shorts.

Stephanie Goss:
I'm taking off.

Andy Roark:
Yeah, I showed up tan lines-

Stephanie Goss:
“Let's get this done.”

Andy Roark:
Out there so that everybody could say like, “Little tiny runny shorts.” I was doing the quad stretch where I'm holding my ankle and other ankle, and Tyler's like … She was wearing yoga pants and a sweatshirt.

Stephanie Goss:
And I saw the picture, and Steph's got her coffee in her hand and I'm like, “There was never the intention.”

Andy Roark:
I was like, “Are you guys going to put your coffees down before the race starts?” And they just both just looked at me like I was so dumb.

Stephanie Goss:
Oh, it's fantastic.

Andy Roark:
We're wired a little bit differently, Tyler and I.

Stephanie Goss:
Oh man. Well, glad to know that we haven't even started this episode, and we're off the rails.

Andy Roark:
Oh yeah. Well, you asked how I was doing. That's how I'm doing. How are you doing?

Stephanie Goss:
Fair. I am excited about this episode because when I read this episode I was like, “Did I write this in our ideas database and forget that I wrote it?” Because it is a hundred percent a situation that I had in my practice, and it came from someone else. But I think this is going to be one of those episodes that people are like, “Hmm, I think they might be talking about my practice.” So it came to us from a practice owner who was struggling because they have someone on their leadership team who is fighting with some of the doctors.
And so they unpacked what fighting means and it was a really good unpacking, but they kind of framed it with like, “Help. I need help figuring out how to keep the peace on my team.” So there are some disagreements when it comes to the quality of medicine that is being practiced.
And so this practice owner was like, “Look, I set the standards for my practice and I trained my manager to uphold the standards that I decided on.” Fair. And now the practice has grown and there's multiple doctors on the team, so it's grown from a small practice to a bigger practice. And so they were like when an associate doctor wants to do something differently than our standard, this member of the leadership team and one of the managers has somewhat of a spicy approach to disagreeing with the other doctors.
And this practice owner was like, “Look, I get it because on one hand, I appreciate and want them to do their job and I want them to enforce our standards of care. I want them to enforce the protocols. That's what I've asked them to do. And on the other hand, they didn't go to vet school, the doctors went to vet school and the doctors are making decisions in real-time, and I need to figure out a way to make this not be a spicy conflict when it arises and figure out how to manage the situation when a non-DVM leader in the practice disagrees with one or more of the doctors on the medicine side.”
And they were like, “It's a really fine line. I have no idea where to start. Please help.” And I just thought that this one was a fantastic one. It's one that we haven't talked about before. And like I said, my mind immediately went to the treatment room into this situation that happened in my practice, and I was just like, “I could have written this.” So I'm excited to talk about this one.

Andy Roark:
I like this one a lot. This is one of those fun balancing different people type problems that I really enjoy. So yeah, this is good. All right, cool.
Well, let's start with some head space just to get into this a little bit. The first thing I'm going to say in head space is this is a classic example of what we're fighting about is not what we're fighting about. Absolutely, there is so much baggage here. The first challenge here is to get everyone to understand what we're actually talking about because otherwise they will not. And so we've talked a lot about this.
I tell a story sometimes about forgetting to get a babysitter when I had told my wife I was going to take her out on a date, and my oldest daughter was like 11 and my youngest daughter was eight. And she was like … The night came and we were getting ready to go in an hour or two, and she was like, “Who's the babysitter?” And I was like, “We don't need a babysitter.” And she was like, “Yeah, we do.” And I was like, “No, we don't. Jacqueline is old enough to watch her and Hannah and we can go.”
And Allison was like, “No, she's not.” And I was like, “Pretty sure she is, and I'll Google it and see what I'll see the legal.”

Stephanie Goss:
Shut up.

Andy Roark:
Ah well, there's legality here. There's a legal precedent. And I am going to investigate it and see what it is. And so I googled it. And 11 years old in the state of South Carolina is the answer. And so clearly I won the argument and then we both just agreed that I was right and we went on a lovely date. That's not what happened. We did not finish the argument the way that I had hoped. It escalated, if anything.
Ultimately, this is an example of the fight is not about the fight. The fight was not about how old the children need to be in order to be left alone. The fight was about Andy didn't get a babysitter even though he said he was going to take his wife on a date and now this is a thing and he really dropped the ball, and he hasn't apologized for dropping the ball– he has made excuses instead. And so that's an argument that's not really about the argument. The same thing is here too. When you go to the doctor and say, “You are not upholding the standard of care.” You are saying a lot of things you are saying you did not take acceptable care of the patient, you possibly don't know what you're doing, you are not worthy of being here based on this result.
People get real defensive about those things really fast. There's a lot of stuff about identity, self-worth, your medical knowledge, your values. Are you doing a good enough job, are you walking your talk, all of those sorts of things. There's an ethical component. You are doing something unethical. You were negligent. “When you say you didn't meet the standard of care,” what I hear is you were negligent in your treatment of the patient. And that's not what the person said, but boy, you better believe all of those things, depending on the individual you're talking to, they come right to the top of mind. And so the first thing we've got to do is know that when you go to the doctor and you confront them this way, if you walk right up to them and say, in this case you did this, you're going to get a lot of strings attached to the response you get back.

Stephanie Goss:
Yes. Well, I mean to your point when you were telling us the story at the beginning of the episode, it's about the stories that we tell ourselves in our head. And I think that's from a head space perspective, I agree with you a hundred percent. It's never the conversation or the argument that's about the thing. It's always something else. And the question is it about something else on both people's parts? On one person's part on? You have to figure all of that out. And so I think from a head space perspective, for me, I think part of it is about where we always start, which is part of the talking about having a safe conversation. And when I think about looking at this, one of the questions that I try and ask myself … putting myself in this practice owner's shoes, one of the things that I would hope that I would do would be to ask my manager, “What else could this be about? What could the vet have – are there things you think that the vet could have been thinking about to help assume good intent?”
Because there are things on both sides. The vets are thinking about other things. They are weighing in things that the manager may or may not know about. And to the practice owner's point, they went to vet school, they have a medical degree that proves them perfectly competent to make those decisions. And there is reasoning there and getting curious about what that reasoning is and why it happened is really I think important to assuming good intent.
And on the flip side, getting curious about why the manager is asking questions is also important because to this practice owner's point, the manager's job is to care about the decisions that the doctor's making because they are supposed to be thinking about things like patient safety and client experience and the impact to the practice and staff retention and staff satisfaction, and all of those things. So they have a vested interest as well. And when you have two parties that are both potentially telling themselves stories in their heads, I think where you have to start is with that assuming good intent and asking yourself part of, am I safe to have this conversation for me in problem-solving this, and I know we're not to actions yet.
But is to ask yourself what else could this mean? Why might they have made this decision ahead of the conversation? It's also one of the action steps that I am going to encourage to the manager to ask in the moment, but teach them a healthy way to do it. But it's important for them to ask themselves that question of, why else could they have made that decision?

Andy Roark:
That is exactly the approach whenever you have these conversations that are not about the conversation, whenever you have these emotionally-loaded things, I would say the little two-pack combo that I would put front and center in head space is exactly what you said, it's assume good intent, first of all. If you go in and say this person failed or you didn't do what you're supposed to do, this thing is already going to go … It's already going to go sideways. It's like right off the bat, this thing is already going to go badly. Just count on it. Assume good intent. Assume the person was acting with noble intentions.
And then the second part is seek first to understand. I'm assuming this person had a good reason for doing what they did. I want to understand what it is so I can understand how it fits into the context of our medical standards. Do we need to make changes to our medical standards? Do we need to make changes to our medical standards or how we talk about them so that in these cases, this is something that it fits into our standards so that … and we can get into it in a second, we're going to start getting into what are the consequences here, what we want to make sure that the team understands what's going on, we want to make sure that the team is able to support you, but they can't support you if they don't understand what's happening.
So all of those are very productive ways to unpack these sorts of things. But I think there's two pieces here. I think number one is when you start to unpack what happened, you better get into a good, healthy, curious, positive head space. And then number two is I would say unpack it and then you need to put all of this aside and you need to talk about what you're going to do in the future. And then you need to have a positive, productive conversation about where are we going in the future. If this turns into the manager arguing with the doctor about a case that happened yesterday, the manager's going to lose, and they should lose because they're not a doctor. They're like, “That's it.” Anyway, I'd say they should lose again, but you get my point. It really does come down to two people, have a clear disagreement about a case, the person who's a professional veterinarian should probably have a stronger leg to stand on.

Stephanie Goss:
Well, and I would say I disagree with that slightly in the sense that I think there have been times where I have had two doctors who disagree on what to do with the case. They're both educated, they both have the veterinary degrees, and they have different opinions or different perspectives. And so I think it's about finding that middle ground to your point about getting curious where you're seeking to understand why are you doing the thing to figure out how are you going to be able to move forward in the future.
It's not about making someone feel right or wrong or you know less than they do because I'll tell you, I've worked with a lot of managers who know a whole lot of things and who will bring about medical concerns that others on the teams may not have brought up. So, I think there's validity there, and it's hard. I get fired up and on my soapbox as a manager who didn't originally come from the medicine side of things when people are like, “Well, you're just a manager, you don't know anything,” and not that's what you said because that's not how I took it at all.

Andy Roark:
No, I didn't want to bring that across. I might need to restate that, but …

Stephanie Goss:
No, that's not how I took it at all. And I think it's important to recognize that we're all telling ourselves some degree of story and filtering it through the lens of our own experience. And so it doesn't matter whether you went to vet school, or didn't go to vet school because you can have two people who even went to the same vet school who have radically different perspectives on how to treat the same case. And so I think it's about that finding that … I'm so glad that you said the seek first to understand because a huge part of that head space is like what are we doing and why are we doing it, are we doing it simply because as the business owner I said we need to have protocols, these are the protocols I set up and you're enforcing them.
Wonderful. I appreciate that so much. I appreciate you doing your job fantastically well. And protocols change. Medicine changes. Medicine is radically different now than it was 20 years ago when I started. We're using different drugs, we're using the same drugs in radically different ways. Things change and things have to be flexible. And so I think getting curious on all three sides of this, because there really are at least three sides here and you brought up a fourth when you talk about the rest of the team, getting curious and asking those questions about, “Why? Tell me more,” is really going to help us get to the heart of how do we tackle this and how do we fix it. And it being future-facing is so important and I'm really glad that you said that.

Andy Roark:
And just to give some color to this because as I say sort of the veterinarian should have the stronger leg to stand on. What I mean, I don't mean, hey, if this person's a vet, then they're right and the other person is wrong and that's all there is to it. I don't buy into that vet worship stuff. And you know that. I think when I say that, I still stand by that as a general rule. And it's a lot of it is because one, yes, there's a difference in medical training, but the bigger part for me is the veterinarian is the one who is in the room. And yes, they're a human being and they're making decisions in the moment on the fly. And I feel like whenever possible, we need to support the person who was in the room making decisions in the moment and who could actually talk to the client and read the situation and see what's going on.
And this is where my point comes from, I'm always a bit wary of someone picking up the medical record two days later and saying, “You clearly did this wrong.” And going in there, I think that that's a recipe for disaster. And so I don't want to overstate that or make it about positions– this person's in the right and this person's not. I just think that when we start to get the benefit of the doubt. I'm a big fan of giving a benefit of doubt to the person who was there, who was looking the pet owner in the eye, who was looking at the pet and who was trying their best and who was working with the information that they had at the moment as opposed to standing back and saying, well, clearly, we have it written down that this is how we do these cases. So that was sort of the point that I was trying to make there.

Stephanie Goss:
Sure, for sure. Well, that feels like armchair quarterbacking, right?

Andy Roark:
Yeah, exactly.

Stephanie Goss:
It's like you're being asked to make a call or make a judgment when you weren't in the middle of things. And so I think there's validity there. And I certainly felt that. And like I said in the beginning, this is … I could have written this and I struggled because to your point, I wasn't in the room but my manager, my leader was– she was the tech on the case with the doctor. And so now I have that situation of two people with medical backgrounds with experience who have radically different takes on how to manage the thing. And now I wasn't in the room, but I'm being asked to make judgment calls on how do we move this forward and holy hell, it's hard. It's so hard.

Andy Roark:
And I have 100% seen those things where a doctor and technician were on the same case and they had very different opinions about how it went. And it's very hard. And if you're the manager who gets brought into that and you weren't there and you didn't see what was happening, boy, it's a nightmare case, it's a hard case. I do want to point out at this point, this is a problem of success in a lot of ways, which means you get problems like this when people care a lot about what they're doing and they care about doing a good job. And so these are not awful problems to have in that they only come around because you have people who are really engaged and who really care. And so I do think that that's a good thing.

Stephanie Goss:
And I think that's one of the most powerful tools for when we get into action steps because leveraging that and acknowledging how much they care on all sides will go a tremendous way towards making this a future-facing conversation and dropping that anxiety level over, “Hey, we've got to talk about the disagreement.”

Andy Roark:
I completely agree. I guess my last part in head space is I would 100% make sure that this conversation is not framed as right and wrong. “That the technician is right and the doctor's wrong or the doctor's right and the manager's wrong.” I would not frame it that way. I don't think that's productive. I think it leads to hurt feelings. There is no arbiter of medical care in the sky who says, “Yes, this was the optimal way to proceed.” That's not even possible. I mean, I'll say I've seen cases where the doctor practiced the pinnacle highest premium standard of care, and the pet owner left and got really angry when they got home because they were like, “I couldn't afford this and you did all of these things and now I'm not coming back because I can't afford you guys anymore and blah blah blah.”
And again, medically speaking, the doctor did the best thing. Yet, there's a client who's angry on the phone saying, how dare you do all of these things when I just wanted my pet taken care of in this basic simple way. And you go, “I don't know what's right.” If you work the case up to the point that the pet owner never comes back again, was that optimal? I doubt it, but I don't know. You know what I mean?
So anyway, that's why … I try to throw those shades of gray in there, not to irritate anybody about what the standard of care should be, but just to say there's not a right answer. There's only guidelines, there's only sort of our values and how we position ourselves. There's only consistency, and consistency is really important. And so when we start to get into action steps, we're going to start to talk about what matters and what's important. But I do think that … I guess we can put this as groundwork, starting to have some agreements in our team about what our values are, about what we care about. Those things are really important for having these conversations. If you don't have sort of team values, core values, things like that that say these are the things we care about, this is a really hard conversation to have. If we can come up with some things that we all agree on about what's important in the way we treat each other about the what's important in the way we treat the pet owners, then we can use those as touchpoints to start to make some standards.
But if we don't have any conversations about what's important to us, what our identity as a team is, then it's really hard for us to make standards because the standards that you are interested in and the standard that I'm interested in, they can be wildly different. And we've seen that. Anybody who's been in vet medicine for very long has seen some practices where they just let the doctors completely run however they want. And you've got one doctor who may or may not be the senior doctor who's like, “No, we're doing it. We're doing old school.” And you've got new doctors who go, “I can't look, I just can't. Look at that.” And I'm not trying to throw anybody under the bus or ageist anything, but just give an example of a common one we see is people who practice medicine very differently.
I've seen old-school doctors who have kept up and done a lot of learning and they are amazing, much better doctors than I am. So it's not anything about anything other like that. I use that as a classic example of doctors doing very different things in the same building. And it happens a lot. And boy is it hard to get them onto the same page, and they can get really defensive really fast.

Stephanie Goss:
For sure. And I think your point is a great one, and when you do have agreements about how you're going to work, what your values are, even like you're going to talk to each other or manage through conflict, which is one of our action steps here coming up. But even if you don't have that, your point about this is a problem of success, they both care. The doctor cares about the patient and is trying to do the best thing for the patient. And this manager or managers or whoever is concerned about it, cares about the patients as well. It's not less or they're caring about … And maybe they are caring about different things, but they both care.
And so starting there and being able to say, Hey, I know we're having this conversation because I know how deeply you both care about your work and I want to use that to figure out how do we come to some agreement on how do we deal with this in the future. Using that works whether you have stuff formalized or not. And it works whether you have … The problem is with all doctors, I had that exact conversation when my doctors all disagreed on how to manage a certain type of case and what kind of drugs we were going to carry. And I was like, “Look, you guys all agree, you're all really smart. I don't have a degree in veterinary medicine. I'm not going to make the call here, but I need us to work together to figure out what is going to be our agreement between us” because the team can't have it four different ways.
And so it's about how do we find that common ground. And so I think that head space of “this is the problem of success” is a really healthy one to help move into those action steps of talking about it.

Andy Roark:
I also think to some degree, it can make the conversation easier when you have multiple points of view because then you can clearly say, “I'm not picking sides.” We need to come together and find a path that has us all doing the same thing. So anyway, I think that's probably where I'd be for head space. So it's just sort of summarize real quick. Remember this is a problem. We're not really talking about the problem. You have to be very careful here about people's emotions, self-worth, self-identity, values, things like that. So just we want to be really, really careful here. The combo to start off with is going to be assume good intent and coach to assume good intent and then seek first to understand is try to understand what's happening, what's going on.
Remember to put your standards of care forward as a living document. Whatever your standard of care is today, that's not going to be your standard of care in 10 years. You're going to continue to evolve and change as we learn things. And so that also makes the standards of care a less scary, chiseled-in stone thing. It's something that we can talk about, and that's okay. Remember the end result that you want to try to get. The end result is important. The end result is not to make the doctor apologize or to take the manager down a peg. If that's what you're trying to do. You are off base. The end result is to come to an understanding so that next time the case comes in, we have some agreement about how we're going to proceed as a team so everybody feels included and safe and onboard, and that's the end result that we're looking for.
And so if you pull the flaming raging sword of justice and you go seeking to figure out who is right and who is out of line, is it the doctor that is wrong and negligent, is it the manager that is overstepping her bounds, none of that's going to end well. In any sort of way, it ain't worth it. Just go in there and talk to everybody and figure out what's happening and what we're going to do next time.
And the last thing I would say is remember just to lay down why are we doing this. And that's going to be my first part in the action steps. “Why is this even important?” And I think a lot of people fall into the idea of, well, this is a test, and there are rules and you broke the rules or you didn't break the rules. And I go, “Who wants to play that game?” That doesn't make any sense. “This person was wrong, and I know the rules and I'm going to show them they were wrong.” I go, “Okay, if that makes you feel better, you can do that, but you should really enjoy it because you're going to have weeks of pain in the neck trying to get past this conversation, and it's fallout.”

Stephanie Goss:
For sure. Okay, well, let's take a break and then come back and talk about where do we go from here, how do we manage this.
Hey friends, I just wanted to talk for a quick second about some maths with y'all because I've been thinking a lot about the workshops and normally, here's where we tell you what's coming up and we've got some great stuff happening. So you're going to want to head to unchartedvet.com/events and check out the upcoming calendar. But I want to talk about maths because if you are not already an Uncharted member, you can attend any one of our workshops and pay $99 a piece. Most of them are just $99. You can do it as a one-off, great and fine. However, that adds up really quick. And if you do the monthly workshop with us, and I've seen some of you there as repeat customers, which is amazing, but you could spend almost $1,200 over the course of the year doing workshops with us. Or you could pay $699 and get a 12-month membership, which means you get all of the workshops that we do at no extra charge.
You also get access to our amazing conversation in the community, our community members, and all of our community resources. And it is hopping over there. We've got conversation 24/7, we have got activities, we've got book club. We're writing our handbooks together in handbook helper group this year. We are talking about development and leadership growth, doing our development pathway this year. We are doing hallway conversations where we're talking about topics. These are sessions that are community-led, community-driven. It is topics about things that are going on in your practice that you want to talk about with your peers. All of that is happening and it's all included for your $699 membership. So simple maths, do you pay almost $1200 for the year or do you pay $699?
If you're not currently a member, you should head over to the website and use this argument to convince your boss: “Hey boss, I need to be a part of this amazing community because Stephanie told me so and because she's telling you that you will save money.” Hopefully that works, but I couldn't resist. I hope to see you at our upcoming workshops again unchartedvet.com/events for everything that's coming. And now back to the podcast.

Andy Roark:
So when we start to manage this action steps, this is just some multipart approach. This is not one where you roll in and swing for the fences. I don't know, maybe other people are better than me. There's no way I walk into this with the idea of we're going to have a meeting and this'll be over. That's a fool's game. That's not going to happen. This is a series of meetings. This is a meeting with the manager and separately, a meeting with the doctors or doctors, and then it's going to be a meeting together. And the reason it's because I'm going to need to get both of these individuals into the right head space to talk to each other. And if I don't do some pre-work to set them up to have this conversation, the whole thing's going straight in the ditch.

Stephanie Goss:
Yes, I would agree with that for sure.

Andy Roark:
So let's talk about the manager. So the manager's the one who's looking at the record and she says, “This is not up to our standard of care. I have a problem with this, I'm upset about it.” Seek first to understand. Same thing here. “What's important to you about the standard of care? You're clearly really in this. Why is this important, I want you to tell me why it's important.” And they'll think to you that you're jerking them around and “I need to understand why does this person care about the standard of care? Is it because they feel like it's important for them to know what's going on as the manager? Is it that they're worried about the perception of the staff of this happening? Is it they're worried about patient care?” I don't know what's important to them about standard of care until I ask them.
And a lot of times, we skip this step. We just start talking about the standard of care as if it is by itself important. The standard of care is just a guideline, but that guideline means things, but it means different things to different people. And it's important for different reasons to different people. And so the first question for me is, what's important about the standard of care? And I need to start to find that out. So do you agree with that as kind of an opening position?

Stephanie Goss:
I love it. Yeah.

Andy Roark:
All right, cool. So I want to talk then, and I want to start to put into the person's mind the idea. So we're talking about the standard care and we're talking about this why the standard care is important. And then what I need to generally do is introduce the idea on standard of care. I need to introduce the idea to this person that standard of care is flexible and it is highly context-dependent.

Stephanie Goss:
Sure.

Andy Roark:
Meaning now it's never okay to be negligent. We know that. However, it's never okay to be negligent, full-stop period. And there are different approaches that we take based on what we see in the exam room and also what the pet is going to allow us to do. We have all sent patients home at the end of the day that should have been hospitalized. They should have gone to the emergency clinic, but they weren't going to the emergency clinic. And we all see that. And so there's plenty of examples about standard of care. It's flexible. And I would sort of say, how do we know what's acceptable, how do we know what makes a good standard of care? And I always try to get vulnerable with people here and say, “You know what, I'm a doctor. I do a podcast for a living where I talk to people about medicine all the time, and I'm constantly learning and I'm constantly updating and things that the inflow of data is absolutely unceasing.”
And then also, spectrum of care data is really blowing up. We're starting to see a lot more coming out about more conservative treatment options and what are the outcomes with this and we didn't have that data before. And so anyway, I'll put forward when we start talking about things like that, the classic one for me was the Colorado State parvo outpatient treatment. And when I was getting trained in everything, hospitalization of parvovirus patients was absolutely critical. That's it, it had to happen. And lo and behold, we end up getting this protocol out of Colorado State that's an outpatient treatment protocol.
And only when we see the numbers do people go, “Oh wow, this is a radically different than what I anticipated the outcomes would be.” And so inpatient parvo treatment gives you about a 90% success rate. And Colorado State's outpatient parvo treatment gives you 80% success rate. So not the same. In hospitalizing inpatient does give you a higher success rate. However, I don't think many of us would say, oh, the outpatient is unacceptable, but we didn't used to know that. That's fairly new. And so anyway, I start to have some conversations about medicine changing and standards changing, and it's all sort of figuring these things out. I'm trying to get this person to recognize that the standard has some wiggle to it, and there's some reasons that we move around it, and it's not a perfect measure. And so what I'm really trying to do is set them up in a position to give the other person grace.

Stephanie Goss:
Well, and I love that. And I think the other thing as a leader, as a business owner, and as a manager that might come out of that conversation is where are the gaps in learning and potential opportunities for learning with the team. And what I mean by that is if you ask the question, how do you know what's acceptable? And the answer is, well, you said that that's what the standard is, so that's what I expect everybody to do. That's an incredible opportunity to teach not only your manager, but also probably other members of your support team about the why. And that is a huge opportunity that is only going to get identified if you ask that question. So I love starting there.

Andy Roark:
Well, and then roll that together with the why is the standard of care important– what's important about it to you? And now you've really got something, and you can see me starting to get the manager rocking just to where they're not going to be so rigid that it's right or wrong, do or die. Depending on the person and where they go, I would start with all of those things and get them to hopefully buy into the idea that this isn't as set in stone as we wish it was. It's just not. And we deserve to at least try to figure out what the other person was looking at and what they were dealing with. And then oftentimes, if I can get them to empathize, and I would love … Again, all of these things are priming this person to have another conversation. And so I want to then try to get them into empathizing a bit with the doctor.
And maybe they don't need to; maybe they're already empathizing but a lot of times just getting someone into that head space makes all the difference in the world. It's like when your kid comes home and they've had an argument at school or somebody was mean to them, and you say to them, “Well, how do you think that person was feeling?” Or “What might have made them act that way?” And it's an example, I'm trying to teach my kid empathy. I'm trying to get them to say, okay, I can understand how that person would've been mad. They shouldn't have hit me, but I also shouldn't have called them Johnny Big Teeth.

Stephanie Goss:
Great.

Andy Roark:
Or whatever. I get it. I said, “But I get it. I understand why that would make him mad.” And again, it is trying to get that. So the same questions I start to have with the manager, and this is not a punitive conversation, it is a hundred percent an empathy conversation, but I'm going to try to get them to think about, Hey, if you were a doctor and the staff was looking up to you and the manager came in and started challenging your medical decisions, how would you feel? What emotions do you think you would feel? And this is just us talking, “Getting ready to go talk to Dr. Smith, but what do you think Dr. Smith's emotions are?” And just get them to hear, “Well, I'd be embarrassed, and I would feel like I'm not being supported.” Totally. Those are all emotions Dr. Smith has. And again, this is me talking somebody else into a healthy head space to go have this conversation.
So, anyway. And then the last part too is I would start to talk about some consequences of what are the downsides of conflict like this that we want to try to mitigate. So for example, if these are things that are happening and the staff is aware of them, I'm worried because here I've got my doctors, and I want to build a workplace that's built on trust. I want my techs to trust my doctors.

Stephanie Goss:
Of course.

Andy Roark:
I want my doctors who trust my techs. I want everybody to trust our team manager, and our manager to trust everybody on the team. And so undermining the doctor credibility and unless we have a really, really, really, really good reason to, is generally a bad idea. And I don't want to undermine the trust that the staff has in this doctor. Definitely not until we get to talk about what happened and where are we, you know what I mean? And again, I can't change what happened yesterday. We can only go forward. And I feel like here at the end, I should go back and put the statement in. I feel like I've tried of made this point, but just to be totally clear, I'm not talking about a doctor being negligent or doing awful things. I'm 100% talking here about a disagreement over standard of care that is well above negligence, but not what our stated standard is for this hospital.

Stephanie Goss:
Yeah. A common example that I can think of is … So, the standard of care for a diabetic patient is we're going to do a full glucose curve and an exam, and you have a set … this is what we're going to do and this is how frequently we're going to do it. And then the patient comes in for the exam. And to your point, the doctor takes in all of the information in the exam room, they take in the info from the owner, and then they make a decision that deviates from that standard of care. Maybe it's doing a mini curve instead of a full curve, or maybe it's sending them home to do a curve at home versus doing it in the hospital.

Andy Roark:
They didn't do an exam because they did an exam three days ago or last week.

Stephanie Goss:
When they were here for an ear infection. And so they were just like, “It's fine.” But it's one of those things that's a deviation that someone is like, “There's a reason why we say that we're going to do it this way.” And that is 100% true. It is also a hundred percent true that the doctor's job is to take all of that information and make decisions with it. And so that's why you're in this middle ground. You are right, and they are right. And now I need to figure out a way for us to work together so that nobody feels like they were wrong here because you're both doing what you're supposed to be doing. And veterinary medicine is about the shades of gray. And there are always going to be times where the doctor says, I'm going to do this instead of this time, or I'm going to make this decision. Or as a manager, I'm going to make this exception for customer service. We live in a world of gray.
And so that's where, to your point, getting them to put their empathy shoes on and imagine, ask themselves a question, what else could this mean, what else could they have been thinking, why else could they have made this decision even if they can't get themselves to have empathy … because I've been in situations where someone has been so fired up and so hacked off that if I ask them, “Could you imagine how they could have been feeling when you called them Johnny Big teeth,” they're going to be like, “Screw you.”

Andy Roark:
That's sticking now. Now that we're using it, that kid's Johnny Big Teeth forever.

Stephanie Goss:
They're like, “No, he couldn't have been feeling anything else except for my fist before I put it in his face.” But there is still a way to get them to feel the empathy. And so if that lever doesn't work, getting them to ask the questions about what else could this be about because we live in a world of gray in veterinary medicine, and there are … That is the job as a manager, that is also the job as a doctor, is to make those game time decisions. And it doesn't matter whether you're a practice owner working with a practice manager, whether you're an associate doctor working with a technician. We have to be able to lead the practice, whether we're leading for our patients in the moment in the exam room, or we're leading the team in front of everybody at a team meeting, we have to be able to lead and do our jobs knowing that we trust each other as a team.
And so we have to come to that place of common ground. And so your job as the middle ground person is to figure out how to get them to find that common ground and acknowledge the fact that you're both doing your jobs. No one is wrong. And we still have to find the shades that talk through the shades of gray hair.

Andy Roark:
Yeah, I completely agree. I just had a recollection of … I got in trouble for this one time of sort of a standard of care thing like this where it was like, I had this little miniature schnauzer and it had a bad corneal ulcer. So one of his eyes, and I don't remember which eye or anything … it was a bad corneal ulcer and that thing was not getting better. And I was wrestling with it and wrestling with it. And I had this, and the lady was this wonderful sweet old lady, but I had her coming in every five to seven days and I was restaining it. And every time she came in, it was our policy at the hospital to charge a recheck exam and to do it. And finally, after four or five times, I said, “All right, well, I'll see you back again.”
And she was like, “Dr. Roark, I think you're so great. Are you going to charge me $100 again today for this?” And I couldn't do it. And I was like, [inaudible 00:50:46]. At this point, I knew exactly what I was looking for. The dog didn't need a full physical exam, I just needed to get that eye stained. And she was wonderful. And she said that to me, and I stopped charging for those exams because I was like, Nope, she's going to come in. I'm going to stain her eye. We're going to see where we're doing, we're going to make adjustments and she's going to go. But she was so wonderful. And again, I understand that some people would be like, no, Andy, you can't do that. You should have charged her a hundred bucks every time. And was it the fact that she was a sweet little old lady? Yeah, that probably had something to do with it. Yeah, it probably did.
And again, but if you sat me down and … And they did. The management said something to me about, Hey, it's not standard of care to do this.

Stephanie Goss:
Yeah, how can you do this.

Andy Roark:
And I kind of said, “I hear that; I'm not going to do it.” And I told them. And again, it was one of those things too where I said, “You guys know me. You know that I take care of my cases, and I work up my cases, and this is rare. But in this case, I feel that this is warranted to be able to continue to give this person the care that they need for their pet.” And again, it was a one-off; it was not a common thing, but again, that was a thing where they said, “No, our standard of care is a recheck examination and a fluorescein stain.” And I was just like, “Come and look at this chart with me. Let's see what we're looking at here.” Anyway.

Stephanie Goss:
Well, you're talking about the why, right? So you have to do that with the manager, but then you also have to have the conversation with the doctor because you got to prime that pump, too.

Andy Roark:
I agree. So let's talk it through. So all of that stuff is the things I'm trying to do to get the manager ready and empathetic and open to having the conversation. And so then you got anything else you would say to the manager or are you feeling pretty good.

Stephanie Goss:
No, I feel good about that.

Andy Roark:
Okay. All right. Cool. So then we go to the doctors. The big things that I want to talk about where the doctors is, this is all much healthier if I can frame it as a forward-facing conversation of like, Hey guys, let's talk about medical standards. How do we want to set our medical standards, how do we want to get the team on board with these? Really, a lot of it is a temperature check on where your doctor's about medical standards. And if you have a team that generally agrees that medical standards are good and important, then we're going to start with the understanding that, hey, medical standards are important. If we have a team of doctors that all want to do it their own way and they don't agree about having consistency across the practice, we're going to step backwards, and we're going to do it.
Just know that it's going to increase the timeline it's going to take us to get to where we want to be. And that's okay. Be kind to yourself, be patient with yourself. The first thing we're going to have to do is get everybody to agree that it's important for us to be consistent, and we're going to have to talk to them about why consistency is important, and we're going to have to sell them on the fact that their jobs are going to be easier because the staff will be able to help them more when they know what we're doing and how we're doing it. And we're going to have to tell them we're going to do better medicine and they'll be better patient care and they'll make more money, or whatever their motivators are, we're going to have to get them to buy into a consistent approach across the board.
So that's the first part. And then after we get them to buy in for the needs of a consistent approach, then we're going to have to have the conversation with them about how do we set these medical standards. And that's sort of the conversation that we're going to need to have.

Stephanie Goss:
The only other thing that I would say about the doctors is that I would probably try and do some poking to get them to maybe … especially if there had been already disagreement and emotions, I would probably do some poking to try and get them to unpack the stories they might be telling themselves in their head when somebody who is non-medical staff is questioning, or even if it was a technician who has license is questioning a decision that they made. I would probably try one-on-one before we have the other conversation, get them to poke at that because if I can get them to be vulnerable, if I can get them to acknowledge to the other person, “Hey, when you ask me the question like this, this is the thoughts that went through my head,” I can help set the stage for the empathy to pour out and for the other party to say, “Oh my gosh, that was not what I meant, I never would have wanted you to feel that way.”
So I would probably do some digging with them to try and unpack what are the stories that they might be telling themselves in their head.

Andy Roark:
Yeah, I agree. If there's a specific case where it's this specific type of case where there's a disagreement, and especially if it was based on something that happened last week, I would do the same thing I would do with the manager of assuming good intent, seeking to understand what happened with this case, “walk me through this, walk me through what's going on,” stuff like that.
And then I think it's good to talk to your doctors, not at this time, not about this, but at some point separately talking to the doctors and saying, Hey guys, we've got our medical standards. How do you all want to be made aware of questions about our medical standards?

Stephanie Goss:
Sure. Yeah.

Andy Roark:
And I would say it to the group so that no one feels targeted out. Like, “Hey, Stephanie Goss. If a person has a problem with your medicine, how do you want to find out about that?” It's not that. It's just, Hey guys, the … So now it's presented as education is constant, standards are always changing, the staff wants to know what's going on. If they have questions, I want them to have-

Stephanie Goss:
They need a process.

Andy Roark:
… the ability to ask. And so I'm going to have them. Any of those questions will come up to us, how do you want me to ask you guys about that? Is this a phone call? Do you want me to do it in our one-on-ones? How do you guys want to want to hear about that? And by talking to all the doctors at the same time, I'm setting the expectation that this is a thing that's probably going to happen and it's going to happen to any of you. And it's not bad, it's just they're going to have questions. And so that if and when it happens, it doesn't feel like this horrible, nightmare, scary scenario.
And the last thing I would say is, great guys, we're going to work together on our standards, and I want to keep those things up to date with you guys. What is the best way for us to educate the staff about what our standards are? How do we want to communicate these things so that people know what to expect and how to best support you guys? And those are the types of questions.
Again, what I'm trying to do here is to get the doctor or the doctors into this head space of, Hey, medical standards are important, and the staff cares about medical standards and they're going to have questions about medical standards. And we are a collaborative team who talks through things like that. How do you want to participate in those things? How are we going to send good communication down the chain? And how are we going to receive questions coming up the chain? Because this is how we work together to make sure our hospital continues to function well, and everybody feels good about what we're doing.
And again, all of this is happening before I put the manager and the doctor or the doctors together. This is all priming the pump.

Stephanie Goss:
Okay. So we have meetings with them all separately, and then we've got to get them all on the same page.

Andy Roark:
Yeah. So we got to get them all on the same page. So bringing it sort of together, I'm a big believer that it's probably best if we have medical concerns to have them go through a medical director. And if we don't have a medical director at all, I think that that may be a problem. It's very dicey for the manager to walk in and drop medical concerns on the doctors. I think that's really hard. Part of my setup for this would be … I think this is where you use your medical director is those complaints and concerns should come to the medical director. That way it's almost like a peer reviewing the case and someone who's got some perspective of being in that situation and has some letters behind their name to carry weight of bringing it in. Oftentimes they may be able to add some context that affects how this is presented.
But I really do think working through your medical director is going to be the way to go. And then going into this, if we're going to have this group conversation, we say we're going to sit down with the doctors to talk about what our standard of care is going forward, or making adjustments or things like that. For God sake, start with commonality. And I think you touched on this at the very beginning. Like, what do we all believe in, what are we all trying to accomplish, what do we all think is important, what are we doing here? And I think if we lay down the commonality, what we're all in, we're all looking to do the best for the pets, we're all looking to do a good job, we're all looking to make sure that we make a positive impact in the world, we're all looking to feel like we're making impact day to day on our patients, us, the support staff, the pet owners, we're all doing this.
Now let's talk about standards for all of us so that we can all feel good about this. So start with commonality first, and then start to lay out the spectrum of what guidelines look like. There's a lot of flexibility in what we can do with guidelines. And so I often like to frame the spectrum to show the absurd extremes because it makes people feel not so far away. So for example, I would come in, I would start to have this conversation. I would say something like, “Hey, look, we do not want to have a zero consistency practice wild west. Everybody's free styling. The patient experience, the pet owner experience is radically different every time they come in. Nobody knows what we're doing or why we're doing it. The techs don't trust the doctors. We are not going to have that kind of practice. We are not. We're also not going to have a practice where we dump patients out in the street without any treatment because their owners can't or wouldn't pay for this set standard of care that we chiseled into a piece of stone. We're going to recognize that pet owners are out of our control. The pets are out of our control. And sometimes we have to adjust to the situation to get the best care possible and to protect the relationships that we have. So we're not dumping people out on the street if they're not willing to do everything we recommend. We're also not running a wild west show where everybody's just shooting it out over each case about what we're going to do and what we're not going to do. Let's get somewhere in between those extremes where we all feel good.”
I like that style of setting down two ridiculous extremes, and people go, “Well, obviously, we're not going to dump people on the street,” but what I'm trying to do is to get the people who like rules and who like to see right and wrong. If I set that down just as a joking way, just like I just did it, it frames the issue to say, there's not a right answer, there's a spectrum, and we are picking a space in that spectrum, and that takes a lot of the no subcutaneous fluids are in, or they are out. It's like, no, look, we're trying to land here in the middle. So anyway, I can lower the stakes a little bit and take away that right or wrong mentality. So I try to set it up that way. But that's the big thing.
And the last thing is focus on the future, not the past. Let's talk about what we want to do next time. And some of this stuff is going to be picking a hill and making it beautiful. I tell a story sometimes when I started landscaping, I didn't know where to start because I was just overwhelmed, and my dad told me to pick a hill and make it beautiful, and then pick another hill and make it beautiful. In a couple years, you're going to have something great.
And so a lot of times in management, you just pick a hill. You're not going to create standards for your whole practice in a week. if there's a thing and there's an issue, let's work on that. We're going to work on nutrition recommendations, and then we're going to work on pain control, and then we're going to work on dental standards, and we're going to keep going. And people say it's going to take years. And I'm going to say, you know what, you got years. This is going to be a lifelong process. And then here's the thing, when you get done, it'll be time to start over again and remake the first ones. So that's that. That's all I got.

Stephanie Goss:
Oh, that's where you choose to end.

Andy Roark:
That's it. That's all I got. All right.

Stephanie Goss:
That was a good one.

Andy Roark:
I just ran because we were getting long. Stuff was getting along. We got to get out of here. So I talked us all the way out.

Stephanie Goss:
You talked us out. No, that's great. I love it. I think that's a wrap.

Andy Roark:
Cool man. All right. Thanks for doing this with me. Thanks everybody.

Stephanie Goss:
Yeah, have a great week, everybody.
Well, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mail bag and answer this question. And I would really love to see more things like this come through the mail bag. If there is something that you would love to have a talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message.
You can always find the mail bag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcastunchartedvet.com.
Take care of everybody, and have a great week. We'll see you again next time.

Vet vs. Wellness Plans

Uncharted Veterinary Podcast Episode 233 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are in the mailbag to take on a question from an associate vet working in a practice that offers wellness plans. This vet is NOT a fan and they share some of their concerns with us in their letter. They are wondering how it can possibly be good for vets to offer them when it directly impacts their ability to make their salary, being paid on production. There are some seriously valid concerns and yet both Stephanie and Andy have strong thoughts about how to get into headspace to help plan action steps as this vet to tackle their concerns openly and honestly with their practice. Let's get into this…

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

Do you have something that you would love Andy and Stephanie to role-play on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag!

We want to hear about your challenges and would love to feature your scenario on the podcast.

Submit it here: unchartedvet.com/mailbag

Episode Transcript

Stephanie Goss (00:00):
Hey everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, we've got an excellent question from the mailbag. It comes to us from an associate vet who is asking two simple questions. Am I wrong here? And what they're asking am I wrong about is, is there a middle ground in a practice that offers wellness plans where the associates, the pet owners, the patients, and the doctors who are paid on production all find a middle ground when it comes to wellness plans because this associate is not on board the wellness plan train. I am definitely on the wellness plan train. I think Andy could go either way, but either way, we had a lot of fun hashing this out. Let's get into this one, shall we?

Meg (00:55):
And now the Uncharted Podcast.

Dr. Andy Roark (01:02):
And we are back. It's me, Dr. Andy Roark and the one and only. Are you ready? Yep. I mean, nope, Goss.

Stephanie Goss (01:14):
It's that kind of day. Listen.

Dr. Andy Roark (01:17):
Oh yeah.

Stephanie Goss (01:17):
There's nothing I can do about it.

Dr. Andy Roark (01:19):
Oh, we've all been that way. But it's just awesome to watch you doing it. When I look at you and go, are you ready? And you say, yeah, wait, no.

Stephanie Goss (01:28):
You got to push the button.

Dr. Andy Roark (01:30):
It's going to be that kind of podcast. Like, oh, this is what we tuned in for. This is They'll get there. They'll get there.

Stephanie Goss (01:37):
Yeah. Today's going to be a fun one.

Dr. Andy Roark (01:41):
I wonder how, wonder how much our audience roots for us. I wonder how many people are like, get it together guys. Andy, you can just pull it together. Andy.

Stephanie Goss (01:51):
Get back on the rails. Well, this one has the potential to go off the rails just because we've been together a lot in the last week. Yes, yes. And I think it's funny because you said something to me yesterday that someone else who knows both of us said to me last week, which just made me laugh, which is we've been working together long enough now and we know each other both really, really well, and we can read each other really, really well. And there definitely are days where you feel like for better or for worse, functional or dysfunctional, you feel like the old married couple.

Dr. Andy Roark (02:32):
Oh yeah.

Stephanie Goss (02:34):
And I think this is one of those episodes because we were together all last week in Greenville because we just had our Uncharted April conference and it's coming off of that. We're both, I think, a little feeling really good and rejuvenated, but also a little punchy and tired.

Dr. Andy Roark (02:55):
Yeah. Oh yeah. That's funny. I've always felt sorry for Maria Pirita who works with the two of us. And so poor Maria last year comes in and joins Uncharted to help out me and Stephanie, and she's brilliant and wonderful and I just didn't realize how much you and I communicate in grunts. We make one-word statements and we're like, oh. And she's like, I'm sorry, did we just make a decision? It sounds like we made a decision, but I have no idea what happened. I'm like, [mumbles]

Stephanie Goss (03:28):
It's totally true. We can look at each other and read each other's body language and expressions and also have half sentences and know exactly where the other is going, and then move on from that thought to a completely different thought because we understood what the other was thinking. And so yes, there's a lot of sympathy for Maria.

Dr. Andy Roark (03:49):
I just remember one time a question came up and I said, okay. And Maria was like, great. Andy's on board. And you were like, Andy's not on board. That was a strong no from Andy. And I just remember her looking at us, like what?

Stephanie Goss (04:05):
What did I miss?

Dr. Andy Roark (04:07):
You said, okay. And I was like, yeah, but I said, okay, like

Stephanie Goss (04:15):
A hundred percent. We've had lots of conversations over this last year of You'll get there, you'll get there. Don't worry. You too in time will be able to read the Okays that Andy gives.

Dr. Andy Roark (04:33):
Yeah, that's totally true.

Stephanie Goss (04:35):
It's like a kid knowing that when their parent says maybe that doesn't actually mean maybe. That's exactly it.

Dr. Andy Roark (04:40):
That's exactly it. I was like, dad said, “maybe” that means no.

Stephanie Goss (04:43):
That means no. Oh, man. How are you doing?

Dr. Andy Roark (04:50):
I'm good. I'm super good. I think the Uncharted hangover is real. Yes. As we say, it's a beautiful thing. It's this feeling of awe. If you've never been Uncharted, it's, it's super special. It is not like other conferences. It's like summer camp. If you did summer camp as a kid and when it ended and you were like, I made all these new friends and I can't go out. It's like summer camp. But instead of archery and horseback riding and canoeing; we have motivating employees that don't want to be motivated, we have HR, we have these business development communication things, but the feeling of summer camp is still there. And so when people leave, they're like, I've got all these things I'm excited about and I've learned so, so much. And also I miss being with my friends terribly. And so there's about a one-day letdown that follows the conference. So I've been living through that for the last three days.

Stephanie Goss (05:55):
Yes, me too. And I will say that this conference felt, it was one of those ones where the conversation immediately picked up in the online community and we had a session. It actually had nothing to do with the, really with the actual workshop, but our friend Dr. Adam Little was speaking and he did a session and of course he's a super technology geek, and I love talking tech with Adam, but he was talking about some technology tools in your practice as a side note to his workshop. And they started talking a lot about Chat GPT and artificial intelligence. And you just recently did a podcast about that, right? With our friend Brandon Breshears. And so, I have been really excited to listen to that and kind of dive into it. I had signed up for it, but I hadn't really done a whole lot with it.

(06:52):
Well, Adam opened the doors and it was like the whole Uncharted community stepped through it this last week. And then Ron Sosa and Ben Spinks and some of the other community members who are super tech nerds, really got in on the conversation and started teaching people how to use it. And literally a bunch of people sat there and signed up for it and practiced with it. And it has been so fun to see what the community is doing with it the last three days in their practice, literally multiple times a day there have been posts in the community like, “Hey, I just used it to make these discharge instructions about how to bring in urine samples for a client.” or, “I just wrote this when somebody declines this test.” And it has been so fun for me. And so mind-blowing, I guess, because I just thought veterinary medicine is not technologically inclined. Where is this going? But it has been so fun to see what the community is doing with it.

Dr. Andy Roark (07:51):
Yeah, I agree that I was surprised by how much artificial intelligence came into the conference. Yes, it was, was on the agenda, but not a lot. And then it just really, as people started to use it at the conference, which again, I love that our conference is workshop based because people start doing the things. All of a sudden people are like, I know how to do this. And then they were feeding on different ideas of what they could use AI for and how to make their lives easier. And now, it's just snowballing in the online community. It's a beautiful thing.

Stephanie Goss (08:19):
And let's be real, we made up some sea shanties and some pirate songs and we messed with it. I think you could use Chat GPT to come up with nicknames for me for the podcast.

Dr. Andy Roark (08:30):
Oh, that's funny. I'll have to give that a try. I've done tons. I've not thought of that,

Stephanie Goss (08:35):
I would be curious to see if it can come up with a better bio than you because you make the best bios ever for people.

Dr. Andy Roark (08:40):
Well thank you. I appreciate that.

Stephanie Goss (08:42):
Anyways, we're off the rails already.

Dr. Andy Roark (08:45):
Yeah, this has nothing. This is a great conversation. This has nothing to do with what we're doing,

Stephanie Goss (08:50):
But we, it kind of does because Adam's workshop at Uncharted was talking a little bit about patient care for our own team members. And one of the pieces of the conversation was wellness plans. And we got a mail bag letter from a practice associate DVM in a practice whose practice has wellness plans. And they were saying that the practice has a goal to get at least a quarter of their clients on wellness plans. And they said, I understand the benefit for wellness plans to the clients, and I actually understand somewhat the benefits to the practice owner from a business perspective. But I feel like wellness plans are actually detrimental to the associate doctors because the doctors in the practice are being paid on production and the setup for their wellness plans sounds like they are maybe pretty significantly discounted from their regular prices.

(09:49):
And so they were saying that on the days when their technician happens to be the person who's also the wellness plan coordinator for that day, they've been struggling to make their revenue benchmarks for their overall patient charges for any patients that are seen that day. And so they were just like, I feel like I cannot get on the wellness plans bandwagon. And everybody has been trying to talk to me about it and talk about the good, talking about being able to see more patients, take care of more clients, that they're going to come back to us when they're sick, et cetera. But they were just really struggling. Cause I feel like our schedule is already full with patients, whether they're sick or well, and this is something that I feel like I'm not getting paid for and I don't feel on board. And they were asking two questions. One, am I wrong? Am I the jerk here? And two, is there a middle ground where both associates in the practice who are getting paid on production, the practice owner and the client are all going to be satisfied with offering wellness plans in the practice?

Dr. Andy Roark (10:59):
Yeah. I thought this is a great question and I love that it comes from the doctor who's like, I don't know about getting on board with this. I really like this. And so I have strong feelings. I have strong feelings. All right. Let's go ahead and start with Headspace as we do. And the first thing I want to do is, the question was, am I wrong about getting on board with this? And I will just tell you, there's no way around the idea, that the devil is in the details. When you start looking at associate vets and wellness plans and compensation. I think we've talked in the past a pretty good amount about the difference in production based compensation and salary for veterinarians and said, I'm fairly agnostic. I can go either way.

(11:47):
And I think there's good pros and cons for having doctors on salary versus having doctors on production. The truth about having doctors on production is it's a game. It's a game, and everybody's going to look at the game and they're going to be like, you're changing the rules of the game. And I am very skeptical that I am going to do as well under the new rules as I did on the old rules. And so the devil is in the details because I have seen people do some shady stuff with wellness plans as far as hiding revenue from the doctors and things like that where it's like, oh, we're going to go to a wellness plan and then you're not going to get compensated for all the other work you do after the initial sales and sort of things like that. And again, I don't mean to throw that out as the bite as an example of how these things are bad.

(12:36):
It's just the devil really is in the details. And you can make these very fair for doctors and you can also make 'em really crappy for doctors. And in a place where the vets take a big hit to their income and they're not going to be excited about it and they're not going to get on board with it. Ultimately the truth is going to come out. It's not going to be a surprise at the end, but the devil really is in the details where you say, should I get on board with this wellness plan that's now being offered in my practice? I go, I have no idea. I don't know. I don't what's in it. I don't know how it's broken out. I think you need to look at it and we'll come back of how you do that. But the devil's in the details.

(13:13):
The other thing I really want to do is just validate the scenery for the associate vets who are looking at this, the switch from having a straight up traditional model of care to a model of care that's based largely or almost entirely on wellness plans. It's massive. It's not like, oh, let's tinker with something. It's a different game. It literally is the difference in a classic, here's a product and you pay for it to a subscription model where it's like, you're going to pay this fee. And there's this weird thing about are you going to come back and get your services? Are you not? What does that mean? Do you pay monthly, blah, blah, blah. And it's a whole different model of what you're selling and what you're putting out. And so just the idea that people are going to be like, sure, let's just radically change the way we do business from a product on demand to a subscription service. That's a huge, huge jump. And so I don't know. I just want to say up front, I can't imagine somebody not having serious apprehension about making the jump if that's asking 'em to make this change.

Stephanie Goss (14:22):
And I think that from a Headspace perspective, the other piece of validating that from the devil being in the details perspective is that the mistake that I have seen a lot of practice leaders make, whether it's practice owners or practice managers or medical directors or some combination when they are introducing the idea of wellness plans in their practice, instead of starting with the why. Why are we actually doing this? What are our goals? Which it sounds like this practice has goals, but I would say if the whole team doesn't understand why you're doing what you're doing, the what becomes even more scary and a place where people either don't ask enough questions or ask what seems like too many questions and obsess over those details. And so I think that one of the pieces that is really important, like you said, is the understanding why you're doing what you're doing and what you're doing, because the perception about wellness plans can be very negative.

(15:32):
There can absolutely be a perception that you're just trying to offer low cost care to get clients in the door. And, I'll talk about it when we get to action steps in and later, but I am a huge proponent for wellness plans. We had them in my practice, and I will tell you that the doctors in my practice were involved in the creation of the plans, and it was no different than our regular standard of care. It for us. It simply was exactly what you just said, Andy, which is a way for pet owners to have a subscription model and spread out the cost of cares, right? And so there is a lot that needs to be understood from the philosophical perspective and then also the practical perspective. And I think it's really important as a leader that part of your implementation plan has to include covering that what and that why.

Dr. Andy Roark (16:26):
Yeah, they're not a panacea. Let's just go ahead and lay that up front, not this end of all your problems sort of thing. And so I think it's important to say that. When you go to wellness plans, you're going to have some headaches you didn't have in your old model. And that is explaining the benefits of the program, explaining what's not in the program. Dealing with the fact that people don't remember what the benefits of the program were or what was not in the program. Dealing with frustrated people who have a plan, but the plan does not cover the GDV surgery that their pet needs, nor did it ever include that, nor would it ever include that. That's just the ongoing community. You're going to have those headaches. It's just part of dealing with human beings. So it's not perfect.

(17:15):
I think my big things for wellness plans, this is why I am such a big fan, is we know that the average pet owner does not have enough money to go to the veterinarian's office based on what we currently charge. Most people spending more than $200 at a visit to the vet is a significant hardship. And a lot of our practices are hitting $200 visits every single time, basically. You know what I mean? Especially if you start putting parasiticides and things like that, heartworm, flea and tick, those sorts of things. Like you guys know that we go we way over that. And that's just not easy for a lot of people. And so that's part one is a lot of people just don't have a chunk of money to take one or two pets to the practice and just pick up a big tab.

(17:59):
And that's not just vet medicine, look at the world. Everything is going to a subscription model. It's kind of ridiculous how much we do as far as subscriptions, and maybe it's a generational thing, maybe it's just a, I don't know, ease of transactions or those sorts of things. But man, everything seems to be shifting over to monthly payments and it's how people do business and it's how they budget and how they pay for things except the vet that comes in at 350 bucks for your annual visit. And so I think part of it is just looking at the world and how it's changing and saying, how do we keep this affordable? And people will tell you all the time, they're not secretive about it. They're like, break this thing up into payments. And so the wellness plan is basically a move in that direction. It's trying to take good pet care and turn it into a subscription, which it just makes a lot of sense.

(18:51):
And again, the devil's in the detail in how you do it. So I agree with you start with why has got to be the first thing, get help the staff understand what we're doing and why we're doing it and how it really helps the pets. And it sounds like based on what we got in the mail bag that's kind of been done as far as explaining why this is good for pet owners and things like that. It's funny, I think a lot of times when we're talking about driving change in practices, why is this good for the pets? Why is it good for the clients? Why is it good for our team? And at some point you have to say, why is it good for the individuals? And those are different conversations we have at different times. But I do think for a lot of things, especially if you're asking for a big jump in behavior, a big change, we do have to unpack why is this good for them?

(19:35):
And it sounds like the practice is maybe done a pretty good job of talking about why it's good for the pet owners and why it's good for the practice, but they came up short in talking to the associates about, Hey, this makes some sense for you. And so that's really, I guess where I want to sort of start to focus our time. Sound good? I think whenever we talk about big change, and I got really into this at the Uncharted conference last week, what does done look like I think is a really good starting point is what does this actually look like when we're doing it? And I don't think anybody probably did that with our associate that's writing in. And so I want to lay down from the perspective of an associate what a really good wellness system looks like and feels like as the doctor.

(20:22):
Okay. So just imagine, again, this is, say we've got a plan that works well and the compensation is set up fairly and all of those sorts of things, but let's just talk about what it does. Okay? We've got a system where as a doctor, you can look at your schedule and know exactly what you're walking into when you have your wellness rooms. So you have your day and you're looking at your schedule, and right now you're looking at your schedule and you have no idea what's in any of those rooms. This could be in as a cough, but actually it's a wellness visit or it's in as a wellness and there's a million things wrong with it and all of these sorts of things. The first thing that happens in your schedule is it gets a lot more clear. Is this a sick visit where I'm going to go in and kind of roll the dice and see what I get?

(21:14):
Or is this a wellness visit where I know exactly what the expectations are? We know exactly what scheduled, exactly what these people are doing. Bam. There's a beautiful clarity that comes with having some of these blocks on your schedule where you go, I do not expect wild deviations here. So first thing is you can look, and I was talking to one of my friends who works in a practice that heavily uses wellness plans, and she was like, these can be more financially lucrative than sick visits when you don't know what you're going to get or if the people have resources to take care of their pets. And it can be a mentally resting day because you tend to be able to look and say, ah-ha, I know what I'm supposed to do. And so I really love that she talked about that. You can leverage your support staff like crazy on these appointments.

(22:00):
Yes. Right? Yes. Because there's a prescriptive thing. Yes, we know what they're doing. We know what they're in for, man, delegate, delegate, leverage, leverage. And now you're kicking butt with your support staff in a way you can't, when you're like, I don't know what this is, I don't know what they're going to do. I don't know what's expected and blah, blah, blah. So first thing is you can leverage your staff. The second thing is that you are able to roll in and do faster, less stressful exams with guaranteed outcomes because imagine what you're supposed to do. It's already been decided. It's already been dictated. You don't have to do the sales job. You don't have to go in and talk to 'em about what they're able to do, prioritize what's important or blah, blah, blah. It's all been agreed to. It's all been paid for. It's already done.

(22:43):
And it's just amazing. One, how that affects communication, how much faster that lets you go. And then also just to focus on giving the person a good experience. They've already paid for this experience, so they're not focused on what's this going to cost and blah, blah, blah. They're just getting the work done. And the final part of this, I'll start to lay down is that, and this is just bonkers, but it is human psychology, is that people do not come into these appointments and then add together what they've previously paid with what they're paying now. It's like when people go into the doctor and they're like, I paid $10 copay. It's like you paid $300 this month for health insurance and a $10 copay, but they don't see that. Or Oh, they're like, man, that was $10. So cheap. People are just that way, which means when you go into these visits and you've got everything laid out for wellness care and you just bang, bang, bang, and you knock it out and then you find an ear infection, boy, how much easier of a conversation to have to say, when you clean this ear, when need to cytology and we need to treat it, or even we talk about doing an ear culture.

(23:50):
Sure. They look at this and we're doing an ear culture and ear cytology and the bill's 200 bucks. Well, it's 200 bucks because all your vaccines are not in there because your preventatives, whatever, all that stuff is paid for.

Stephanie Goss (24:01):
Yep. That 200 has been taken out of it.

Dr. Andy Roark (24:04):
Yeah. Well, first is, if you didn't have the wellness plan, you go in there and they need parasiticide, heartworm, flea, tick, they need a fecal test, they need a heartworm test, they need blah, blah, blah, and there's an ear infection. Now they're looking at a $500 bill and they're going, there is no way we're doing this. It makes our jobs easier and better, and when they have to pay for additional things, it's not such a big deal because they're not also paying for the base care that they came in for right now, and they just don't think about it that way.

Stephanie Goss (24:34):
Yes.

Dr. Andy Roark (24:35):
And so that, that's it. And if you think about it, so that's just sort of a stress approach. So when this works well, you know more what your day is going to be like. You can leverage your staff better. You can get in there and have them just help you knock things out. And they know what's expected. You're not talking about money all the time. You're getting in there, you're just doing the care. You're doing the warm-fuzzy relationship part, and the person's leaving without getting their wallet out and they feel great about it. And then when you do find something, there's more chance that they're going to say yes, because hey, we got an ear infection. It's going to be 120 bucks to treat it when we do cytology and medications and blah, blah, blah. And they go, 120 bucks is okay, as opposed to me dropping it on top of your full wellness exam and making it 380 bucks, they're going to say yes.

(25:21):
And so that's when I go back to my friend, the associate vet who wrote in and say, look at this with me. You've, you've got more stability in your schedule. You've got more clarity about what's happening. You've got it set up so that you can lean on your support staff to rock and roll more smoothly. And then when you find other issues, you are more likely to get the green light to do good care, which is good for the pet owner. And I don't mean to be gosh, but you're going to get paid for that work that you would not otherwise be able to do when you break it up like this, you're a whole lot more likely to be able to do the urine culture you want to do or the ear culture that you want to do or to do topicals as well as oral antibiotics for the skin infection, which we know we should do. Yes. But sometimes people are looking at their wallet and they go, I can't do all these things. Yeah. Well, they're more likely to look at their wallet, have the same amount of money in their wallet that day and say, I can do all of this. And so ultimately it can be more lucrative for the doctor.

Stephanie Goss (26:24):
And I think your point about knowing what you're getting into from a wellness perspective is really important. And the other piece of it from headspace and a “why?” perspective that I think as a leader is very important to talk through, not only with your doctors but with your team, is it allows you significantly more reliability when it comes to the sick appointments. Because what you just talked about the getting to yes, with those sick appointments who are on wellness plans, whether they get a significant discount on continued care outside of their wellness plan or not, that point is moot because of the psychology that you were just talking about. So now instead of having an appointment book that is jammed full of sick patients and you have no idea whether people are going to say yes or no to the appointments, now you can start to look at your sick patients from the ease of getting to “Yes.”

(27:23):
Because statistically, we have shown as an industry the significant psychological impact that it has on our clients. The clients have told us there have been multiple studies from the lifetime of care studies to the numbers that come out from some of our corporate industry partners who do wellness plans all day long that show the significant increase, sometimes three and four times the normal amount that a client would spend on a visit when they are on a wellness plan because they're able to split it up and they're just doing it unconsciously in their head because they're not thinking to your point about that money that they already spent. And so when you're talking about the wellness plans, we tend to focus on the wellness care, and I understand where this associate vet is coming from because we have wellness appointments and puppies and kittens coming out our ears after covid, and nobody wants more wellness appointments on their schedule.

(28:16):
And I hear that and I get it. And it provides stability when it comes to those sick patients as well, because it allows us to plan for those things and have the easier conversations with the owner, particularly when we're talking about wellness plans that might build in some annual blood work or whatever. Then if you have a pet that's sick, you have the opportunity to use some of those plan benefits in a kind of an outside the box way that might benefit the patient. It makes getting to that sick pet to a yes a lot easier. And that's a step that I think a lot of us miss when we're setting up the why with our team. Yeah. It's not just about wellness. It's not just about puppies and kittens. It's not just about making sure that they all get spayed and neutered because we're offering it in a nice package with a bow around it. It really is about spreading out those payments to help more patients get more care that they actually need. And especially if you're approaching it from the place of your individual practice's standard of care, you're just allowing those clients to have access to that care that you would be recommending anyways. And so I think it's a headspace piece for sure that a lot of us miss when we are setting that up with our team and talking about the why.

Dr. Andy Roark (29:31):
And I just want to emphasize, again, I'm putting this forward as a blissful representation of wellness. I don't want anybody who has wellness plans to be like, boy, it's not like that for me every day. It's like, no, I get it. I said this. I wanted to put forward what done looks like. Meaning, when this is in place and everything has been adjusted and it works really well, where are we trying to get to? Because if you don't understand what done would look like or what the aspiration is, it can be challenging to get started. And also you don't exactly know where you're going. I want to sort of jump in and piggyback off of what you said as far as the wellness appointments and people don't want more wellness appointments on their schedule. Again, when this is set up and it runs really well, boy, those wellness appointments are your bread and butter.

(30:21):
You just count 'em, they're already paid for. You just got to go in and do the thing you've already agreed to do. Smile, shake hands, be friends. And man, it's easy to be friends with people when they don't have to get their wallet out that really makes it, and honestly, it makes it more enjoyable. Sure. You get to feel like the great doctor that's practicing when money's not a thing and that's aspirational. I think that that's really, that's really great. I just think it helps us all feel much better about what we're doing. The other thing that I would put forward too is this, and I talk a lot about this in the exam room and exam room communication, being able to be a master communicator and really educate and get a client on board with you, that doesn't make you a great vet.

(31:11):
What makes you a great vet is being able to get pet owner after pet owner after pet owner, after pet owner on board with you. I know a lot of vets who can be amazing and once every other day they decide to walk into an exam room and be amazing, but the rest of the time they just don't because it's hard to put on the show and get people on board over and over and over again. And I'm just being really, really honest here. It is hard to get up yet again to go in and talk to these people who don't want heartworm preventive about the fact that they need heartworm preventive. To talk to these people with this overweight pet again and again and again and again and just say, here's another one. I got to get up and go have this hard conversation.

(32:01):
And it's not so much having the hard conversation with a pet owner. It's the grind of having X number of appointments a day and trying to get up to be persuasive, advocate effectively for the pet again and again and again. And so one of the other things that I think, and again, I can't back this up with the research, lemme just say that I can't, this is just my perception. You guys can feel your gut and see if you agree with me in what I'm saying, but if I can get wellness plans locked in so that people are coming in and they're already agreed to what we're going to do, then that lets me save my emotional energy until I need to have that conversation and I need to be persuasive and I need to advocate because once I got on the plan, the advocacy for wellness care is already done, and that lets me just keep it in the gas tank so that when the person comes in at the end of the day, I can lean forward and have that conversation and put that effort into being persuasive into being a strong advocate because I haven't been a persuasive strong advocate all day long.

Stephanie Goss (33:04):
Right, right. Yeah. Oh, well, do you have any other Headspace thoughts?

Dr. Andy Roark (33:12):
No, I think that that's it. I, again, I think that starting off the devil's in the details, know that upfront and own it. This is always scary. It's always going to be scary, especially when people are paid on production because basically you are not changing the rules of the game. You are asking them to play a different game and trust you that it's going to work out for them. And that's a big jump and just know why it's there. I think your point of start with why is excellent, and then I just always say, what does done look like? Let's start with the end in mind. And I really tried to frame this hard. I don't want people to think that this is how I think a wellness plan is necessarily, but I really wanted to frame it up very much for our writer, the associate veterinarian who's thinking what's in this for me? Sure. That that's kind of how I want to set this up. So that's really the head space. And then I think, let's take a break and in our action steps, I think what I'd like to do is try to give our writer some action steps on how to navigate where we are going forward.

Stephanie Goss (34:11):
I love that because I've definitely got some ideas about how to have the conversation even midway through the process like this associate is with their management to understand those details because I think you're spot on with the devil being in the details, and I would love to talk about some of the things to ask to help yourself understand.

Dr. Andy Roark (34:31):
Sounds great.

Stephanie Goss (34:34):
Hey everybody, it's Stephanie, and I'm going to jump in here real quick for one second to make sure you know where to find out all about the things that are coming up at Uncharted. Now, Andy and I started out this episode. We were talking a lot about chatGPT and AI and some of the super nerdiness that happened at the recent Uncharted Veterinary Conference when we were in Greenville in April. And unfortunately for you, this episode is airing on May 24th. And you know what happened today? My friend Jen Quammen did a workshop for our Uncharted community and for you about using AI in practice. And when we first started talking about doing this workshop, I kind of thought it was a little nuts because I thought veterinary medicine does not adapt to technology. We are not tech savvy by and large, and really are we going to have the AI conversation?

(35:22):
And let me tell you, my mind was blown about the possibilities of how you can use this in your practice. I saw my colleagues and myself dive into trying it with some encouragement from our friend, Dr. Adam Little at Uncharted, and oh my gosh, I have used it literally every single day since I have come home to do something to help make my life run smoother. It is awesome. So unfortunately for you, you missed that workshop today, but you can still head over to unchartedvet.com/events and check out what is coming up so that you are not in this position again, where you are finding yourself sad because you missed another amazing workshop because we have got all kinds of stuff coming at you in the back half of the year. So head over to the website and check it out. And now back to the podcast.

Dr. Andy Roark (36:12):
All right, well, let's jump back into our action steps here. Okay. Sound good? All right, cool. So is, okay, so let me frame up where I see our position as an associate vet. It sounds like this is a change that is happening or has already happened, and so I don't know that even if we wanted to, we could dig our heels in and shut this down. It seems like this is going to be something that is, it's going to happen. The volcano is erupting, right? We can try to dig our heels in and we're probably going to get run over by lava or we can make some adjustments to where we're standing and even possibly figure out how to get into a really advantageous position, but I don't think we can stop it. And so I would start with that.

(36:59):
I think we start with our safe conversation that we talk about. Can I smile at the boss, the implementer of the program? Can I assume good intent? I think how you shoot yourself in the foot here as the associate is you say you go in with this idea that the person is trying to screw you over, right? They're trying to not pay the vets, and that's why you're doing that. I think that is a really bad faith position. And so you need to get into a good faith position to discuss, which is help me understand. Can we talk about what good collaboration looks like for us? So assume good intent. Have they been set up to fail? Are there things that you think maybe they haven't thought about or concerns that you think might come up? What are those? And can we present them in a non-emotional way?

(37:53):
So has the person putting this project forward been set up to fail? And the last thing is the end result. What do I want the outcome to be? I've painted for you the picture of what I think a beautiful outcome looks like. I'm not saying it has to be your end result, but I think that would probably be mine is to say, this is really where I kind of want to go. And I think if you, you know that and where you want to go and you've got a good headspace, I think you're already in a good place to go there. Remember that your relationship between the associate vet and the manager or your associate vet and the medical director or associate vet and the practice owner, remember that it's just a relationship. And in a relationship, everybody wants to be heard. Everybody wants to feel valued, everybody wants to feel respected.

(38:34):
And in all of our relationships, we need to be able to set boundaries. We need to communicate to people where we are, what we're feeling, what we need to go forward, and we need to hear where they are and what they're feeling and how they need to go forward. And so don't go into it as a do or die ultimatums and blah, blah, blah. It's just, Hey, you and I are in a relationship. I want to have clear communication about where my head's at, what my concerns are, what I'm looking for. I want you to know that I hear you, and I'm not trying to be argumentative or shut you down. I want you to be successful as well. Let's talk as two people in a relationship about what we want our relationship to be going forward and take care of each other. And I just think that that's really healthy.

(39:14):
I guess I should go into Headspace, but I think that that's a good action step of get yourself into that place so that we're ready to have an open dialogue so that we know what our concerns are and we can put them forward in a way that the person can actually hear them. I think a lot of times what happens is this is a radical change, and so the associate vets panic and when they panic, they say, this is terrible. It's never going to work. And it's awful, and I hate it. They're unarticulate about what exactly their concerns are. So they go, I hate it. I don't want this. It's going to be terrible. We're going to go out of business, things like that. And I say that I've been, I have a hundred percent been that person, right? Sure. It is very hard when the world changes for us to immediately go, let me articulate the six things that are causing me concern at the moment. That's not how we are. We're like, it's all terrible and it's all burning down.

Stephanie Goss (40:09):
I'm living in a cardboard box in the forest.

Dr. Andy Roark (40:11):
Exactly. This all ends up with me dancing for money on the street corner with a hat in front of me. That's where this ends. And so anyway, a little bit of prep work to figure out. Okay, good headspace, open dialogue, clear articulation of what my concerns are. I think that's where you start this. Do you agree?

Stephanie Goss (40:38):
Yes. And I want to take where this associate started in their letter. So part of the email that they sent to us was talking about what they are getting from a production eligible dollar amount for wellness plan visits. And so they were like, we get X dollars for the exam, X dollars for a vaccine or for a fecal or for blood work, et cetera. And they're comparing it to what a non wellness plan visit would be, right? And it feels like a very big gap. And so this is where we tie the headspace and the action steps together. And to your point, when you're ready to sit down and have the safe conversation, what you need to articulate is help me understand. My immediate scared voice in my head is saying, let's just focus on these wellness numbers. Help me understand what this translates to for my caseload, like my average caseload.

(41:37):
Yes. Help me understand what this translates to if your practice owner or a practice manager has done the why and has explained it to you, or if they have it, help me understand how this could impact my sick patient visits for my actual caseload. And this is a step where so many managers and practice owners, we didn't, and practice leaders, medical directors, we didn't. They didn't go to business school and maths are hard. Y'all like maths is a really hard thing. Not everybody loves spreadsheets the way I love spreadsheets. And so when I did this in my practice, my brain immediately went to, well, if it was me, if I was one of my associates, I would want to visualize it. I would want to know how my production could be impacted for better or worse. What is this going to look like?

(42:37):
And so I immediately went to that place of problem solving from a statistical perspective. Start with that fear and just say, help me understand what that looks like. Now, they may not be able to do that on the spot for you because maths are hard, but it gives you a place to ask for what you need because part of the why should be understanding as an associate who is being paid on production, how is this potentially going to impact you? And using real numbers, not just pretend numbers or statistics that the industry is giving you. I said earlier, my experience was I have had clients spend three or four times more than they normally would or more than their normal average transaction. And that is true. And we know that the industry average is I think 58 or 60% statistically when we look at the corporate practices who track numbers for wellness plans on average, clients spend like 58% more for their visits over the course of a year when they're on a wellness plan.

(43:34):
That's a significant increase. But what does that actually do for my patients in two ways? One, what does it do for me from a numbers perspective and a production perspective, but what does it also do in terms of care and accessibility of care and affordability of care? And I think starting from that place of fear, getting a little bit vulnerable, getting a little bit brave and saying, Hey, I'm really afraid of this. When I'm looking at it and I'm looking at the numbers, my brain immediately is telling me I'm going to take home 50% less. That's how I've done the math. Help me understand what this actually could look like for me. If you said that to me as a manager, I would immediately be able to put on my empathy hat and say, oh, okay. I could solve this problem. Let me help you by answering your questions.

Dr. Andy Roark (44:24):
Yeah. There's two things I want to pick on real quick. And again, we weren't there and we're hearing this through the associates, so I don't know what the messaging was. So I don't know if this was said or if this is what was interpreted or grabbed onto or how this was rolled out. The first thing I'll say is I think if it was rolled out as, Hey, we're going to do these wellness plans so you guys can see more cases in a day, I think that was a faux pas. I hope that's not, when they drafted that on paper, what are we going with? Here's how we can get more cases into the hospital. I hope they didn't go with that as a selling point. And again, it's because if you stop and you think about it, the doctors are going to immediately be terrified by that because they're working as hard as they can and part of the support staff as well.

(45:15):
And so if I could step back and coach the manager rolling this thing out, I would say I might not lead with that. I might talk about we hope that this will be more efficient and we're going to be able to move cases faster and we'll be comfortable later on increasing our volume because this is going to be so much more efficient. But we're going to see how it goes. Sure. The biggest thing is we want to get wellness plans going to help people with payment for their being able to provide care for their pets. And so I would not have led with, Hey guys, the plan is to ratchet up the cases, and this is how we're going to do it because nobody's going to jump on that. It's one of the big things is when you're trying to get buy-in from your team and you're ruling things out, you need to talk to your team about what they care about.

(46:01):
And they're not saying, oh my gosh, I couldn't see any more cases today. Dog gone it. I wish there was a way to run more. I don't know why they're, they're this character, but they are. They've got a big hat and it's made of mesh in the back, a baseball cap. And I just couldn't get another case into my schedule today. And boy, that was sure was a big bummer on my day. Oh, well, they're not. That went somewhere else. But that's not what they're thinking. They're, what they're thinking is, I'm overwhelmed. I'm overwhelmed. And so don't talk to 'em about getting more cases in. Talk to them about handling the cases they have more efficiently so they're not feeling so overwhelmed and they're drowning every day. And that's how we have the conversation. And then crush the program, make it amazing, make it great.

(46:54):
Train those techs and support staff so that you can do this. And then when we're moving clients effectively and efficiently, we can talk about increasing our caseload because we're able to run like this, but I just think, Hey guys, trust me. We're going to make a big jump. I don't know what you're going to get paid. I can't prove to you you're going to make more money. And also you're going to see more cases. That is a really hard sell. And so again, I don't know that they rolled it out that way. I'm assuming they probably didn't, but I would've ro this out in phases and said, here's the why and we're going to give it a try. And my hope is that we are going to be efficient and smooth and low stress, and we'll be able to handle a bigger caseload than we are now.

(47:40):
But that's down the road. And that's kind of how I'd put it forward. So that's the first thing I wanted to pounce on and just sort of say, the messaging here may not have come off the way they wanted. The other part, I would say, to be fair to the managers or owner rolling this thing out, one of the real challenges about this particular change management is you don't know what's going to happen and you can't know. And at this point, a bunch of the ops nerds will push me out of the way and go, “Ah-ha! Excuse me. We have a spreadsheet that explains exactly what is going to happen.” I'm like, you have no idea. You have no idea who's going to actually pay for this. And who's not and what uptake is going to be you don't know. And you should just be honest about that and say, oh, I don't know what the uptake is going to be.

(48:33):
But that does make it hard to go and talk to the doctors because they say, what's this program going to do to our income? And you say to them, I have no idea because I don't know how many people are going to do it. I really honestly don't know. I don't know how many sick things we're going to find on top of the wellness things. I don't know how many people are going to buy a wellness plan and then not come back in to get their services, which is bad for the pet, good for the practice, bad for the doctor. You know what I mean? That's not what we aspire to. And I would be very upfront about that. This is not the gift card scam where we sell gift cards knowing that only 75% of people are going to ever actually spend that gift card, and we're going to pocket 25% of the money and never return a service.

(49:18):
It's not that. And we don't want it to be that. And you need to beat that drum really, really loudly. So anyway, that, I just want to call that out in on behalf of the person rolling out the program as you go. I don't know what to do about this. And so now we're sitting in this place and we've, the doctors are, they're kind of freaked out about their revenue and what they're going to make and is my salary going to crash down? And the owners are, honestly, they're freaking out because they're taking a risk on this and going, we don't know it's going to work. We think we've priced it well, what if we screwed this up and we're just going to get taken advantage of? Everybody's got a lot of stress about this. I think that one of the things that I might ask for as the associate vet going in is to say, and again, the devil's in the details here, but I would go in and say something like, look, I'll make you a deal.

(50:04):
I'll go hard in the paint on this project for you, and I'll go hard in the paint for three months and you're going to guarantee my salary during that time, yes, you are going to pay me what you paid me last quarter. And that way I'm not worried about my salary crashing down, but we are going to do it, and you're going to pay me what you paid me last quarter, and I'm going to go hard for you. And then in three months, we're going to come back together and we're going to both look at the numbers and you're going to show me the numbers and we're going to look at my production. We're going to talk about what my days are like, and we're going to talk about how we like it, how things are shaping up. And if my production is a fraction of what it used to be, and I'm working my butt off here going hard for you, I'm either not going to get on board with this or we're going to need to make some adjustments and changes so that it comes out and it's fair.

(50:54):
But I will give you my word. I'm going to go hard on this for you. I am not going to sandbag. I am going to be in there. I'm going to hustle. I'm going to do it, but you are going to protect me while we pilot this program. And then when it works, you and I are both going to be happy. We're going to high five, we're going to look at the numbers. We're going to figure out that I would've actually made more money had I switched over. And you can either credit me that additional money to really sweeten the pot and say, well, actually, you over earned what I was paying you. Or we can just decide that that's the risk of the pilot program, but let's decide upfront so we don't get three months from now. And I go, great. You owe me more money.

(51:34):
And you're like, Nope. You said guarantee your salary. That's what it is. Let's just work that out now. But anyway, not to get bogged down in the details, but you see where I'm going with this, right? One of the ways to get the doctors on board is you have to protect them. You can't say, I want to do this new program and I'm shifting the risk onto you financially for us to try this anyway. So that would be a big action step that I would kind of go in and say, this is what I need to get excited about this. And it's not forever, but I will pilot this with you and I'll be your champion, but you're going to protect me while I do it. And then we're going to both have a real transparent look at the numbers and how it went and what's fair going forward.

Stephanie Goss (52:18):
I love that so much. And here's the thing. I think a lot of us as leaders, when we're setting up things like this, think about it in terms of forever. We think we have to go all in on wellness plans and there's no going back and we can't change things. And the reality is you're in charge or maybe you're not. If you're in a corporate practice, then maybe somebody else is making the decisions. But there is always some measure of control. And to your point, I think there is always the ability to have the open and honest conversation and say, this is the timeline. This is what we're going to try, this is how we're going to try it. This is how we're all going to show up and commit to each other. And then we're going to look at it. And so if you start doing wellness plans and six months in or 12 months in, you're like, I would like to make changes, do it.

(53:13):
It doesn't have to be, we decide one thing this year with the team that we have, and then a year from now your team looks completely different and you can't change it. You can better it for yourselves. You can better it for your clients, you can better it for your patients. We have got to stop thinking we're going to make this decision today and this is the decision that is going to live on forever. Because I will tell you to a point that you made that is really good one at the beginning of this conversation is that it is a process and it is from a workflow and efficiency perspective, if you already have inefficiencies in your practice, wellness plans are going to highlight them like there's no tomorrow and it is going to be a rocky road to get to that vision of done.

(54:00):
And eventually if you keep plugging away and everybody keeps rowing in the same direction, you will get there. But it is not a smooth and easy process if you don't have a lot of that stuff hammered out. And so I think from that perspective, leading this project is really important to put the hat on of “when and how do we make the changes?” And I think it's great if that suggestion or that ask came from the associate, I would love it. And I think as a leader, don't be afraid to go out on that limb and say, this is how I'm going to help minimize the impact to you. Whether it's to the team who's getting paid on production or doctor who's getting paid on production or just the overall volume in patients. All of those things like factor that all in and try the thing. It doesn't have to be forever.

Dr. Andy Roark (54:51):
Right. No, I agree. I think that's pretty much what I got. I think that would be my headspace going into it. I hope I painted a good picture of what this can look like for doctors and how it can be good. I've said it way too many times, but I'll just go back to it again. The devil is in the details in a lot of this stuff. How is it set up? I think there's also strength in, I said I, I'm agnostic as far as paying doctors on production versus paying 'em on salary. They just have different headaches. Neither system is perfect, they just have different headaches. And I'm like, salary doctors can be a way around these sort of compensation headaches. But honestly, there are a lot of practices and honestly, big corporate practices that leverage wellness plans and pay on production. It can absolutely be done. It can be done very fairly.

Stephanie Goss (55:44):
Yes, I would agree with that. And that was kind of the last question that had been asked in the mail bag. Is there a middle ground where everybody comes out well? And I would say in my personal experience, absolutely. Yeah, there has to be. Absolutely. And I would say one of my close friends practice kind of was a model for us because they had been doing wellness plans for longer than us, but I will tell you had been, by the time they had been doing wellness plans for eight years, they actually had 80% of their patients on wellness plans and their ACT was well north of $300 per visit. Yeah. Which that's great. Which is great. Great. And it was the patients were getting care and the clients were happy. And so it absolutely can be done. It takes time, it takes focus, it takes talking about those details. To your point, Andy, and so I think my message to our associate writer is like, don't be afraid to ask those questions. You should understand the why and the how, and to your point, do it safely. Think about it. Think about what's making you panic, but write it down and then ask for it. Yeah.

Dr. Andy Roark (56:50):
No, I agree. All right. I think that's all I got.

Stephanie Goss (56:52):
All right. This is a great one. Take care everyone. We'll talk to you again soon.

Dr. Andy Roark (56:56):
See you everybody.

Stephanie Goss (56:58):
Well, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mail bag and answer this question. And I would really love to see more things like this come through the mail bag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mail bag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody, and have a great week. We'll see you again next time.

Letting Go of the “I’m Giving My Notice Guilt”

Uncharted Veterinary Podcast Episode 232 Cover Image

This week on the podcast…

This week on the podcast, Dr. Roark and Stephanie tackle a topic from the mailbag. Dr. Fed Up writes in and asks for help with letting go of their guilt over giving their notice at their new practice. Dr. Fed Up was hired as a new grad and promised support and mentorship. Fast forward to the present where they are often working alone with no other DVM present in the building and tackling a full surgical caseload that they don’t feel confident tackling. Dr. Fed Up wants to quit and move on to something that would be a better fit for them but is struggling with 3 questions – How do I tell them why I am leaving, how much notice do I give and do I feel guilty that the leaders of this practice may have to close a location (temporarily or permanently) due to lack of DVMs?

Let’s get into this…

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Do you have something that you would love Andy and Stephanie to role-play on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag!

We want to hear about your challenges and would love to feature your scenario on the podcast.

Submit it here: unchartedvet.com/mailbag

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Episode Transcript

Stephanie Goss (00:00):
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. So this week on the podcast, Andy and I are tackling another topic from the mailbag. We got a great email from Dr. FedUp who is a new grad working in a big busy practice. It's a multiple doctor private practice with multiple sites within the practice. And this doctor thought that they knew the practice pretty well. They did extensive interviewing, they felt like it was a good culture fit for them, and they got there and things have not been going according to plan. They were promised really great support and mentorship, but by their third day they were thrown onto the schedule with no other doctor present at their location and a full day of surgeries, which really struck Dr. FedUp out. So we are going to dive into their questions, which revolve around how do I give notice if I have decided this is not the right fit for me, and how do I let go of the guilt about leaving and the fact that they are now short doctors and might have to close a location. Let's get into this one.

Meg (01:08):
And now the Uncharted podcast

Dr. Andy Roark (01:13):
And we are back. It's me, Dr. Andy Roark and Stephanie. Crap, I forgot what I was going to say. Goss. Alright, hold on. We're going to pause here for a second. I completely, oh, alright. I'm ready now. Yeah. Okay. No, we're, this time I'm really starting. Here we go. And we are back. It's me, Dr. Andy Roark and Stephanie-Peace-out-Girl-Scout-Goss.

Stephanie Goss (01:46):
This is going to be a good blooper episode.

Dr. Andy Roark (01:49):
Oh man. No, we're, we're going to pull this together and we're going to land it with grace and style.

Stephanie Goss (01:54):
How's it going Andy?

Dr. Andy Roark (01:55):
It's aside from the obvious stumbling on the starting line of this podcast. It's pretty good. It's pretty good. I have been back in the yard because it is beautiful here and I am pulling weeds and getting my yard cleaned up, which I love and it made me think I'm just going to, so one of my favorite things is life lessons from gardening with Dr. Andy Roark and in this episode of Life Lessons from Gardening with Dr. Andy Roark, I always want to talk about two quick things. Number one, over the summer I did not pull weeds in my yard because it's 90 degrees and 90% humidity in South Carolina and it's terrible and I just didn't want to do it of course. And I felt terribly guilty that these weeds were growing in my yard and I was like, this is awful, but I'm not doing it because I don't have the energy and I don't have the time and blah, blah blah.

(02:45):
And then the weather turned and it was beautiful. And in four days I have weeded the yard and gotten everything like trimming stuff back and it's coming back into form so beautifully and making me so happy and I'm so enjoying doing it and I just want to call that out as a metaphor for practice. There are times when the weeds get out of control in our practice because we are so busy, because we have so many things going on because we just don't want to deal with it. That's not failure, that's not the end of the world. That's just the cycles of life. And I think that a lot of us are too hard on ourselves when we look around and we go, God, the break room is dirty and we still haven't figured out this policy and we haven't made this decision yet and I feel like I'm failing.

(03:32):
And the truth is, you can get all that stuff done if you want to, when you want, the time will come around and you can get motivated and you can do it and it will be fine. But beating yourself up because you cannot do anything more than you are doing right now. That does not make sense. And the other metaphor I want to say is I'm looking at this cluster. I've got three bushes, I've got a beautiful Oak leaf and I've got a beauty berry and I've got this other sort of shrub kind of thing that I forget the name of right now. And they're all gorgeous plants. The problem is they're all right on top of each other and the most beautiful thing that I can do for my yard is to get rid of one of these beautiful plants. And I love that analogy because so often in our practice we have three beautiful plants that we're so proud of that are all so wonderful that we really want to take care of. And the truth is the best thing we could possibly do is get rid of one of the beautiful plants and just focus on a smaller number of things. So those things have the space they need to grow and evolve. And so this has been lessons in life Gardening with Andy Roark

Stephanie Goss (04:44):
That. That's it. That's, that's all I got. That started us off on such a deep note. Cause where I was going to go with that was, hey, I saw on social media you had a crate full of puppies.

Dr. Andy Roark (05:01):
I also had crate full of puppies yesterday. They were labrador retriever puppies. No, no good stories there. Just nine of them. Litter of nine, adorable labrador retriever puppies, they all came in a crate. They were a hundred percent asleep too. It was a crate full of sleeping labrador retriever puppies.

Stephanie Goss (05:22):
I was not thinking on the depth of life lessons gardening with Dr. Andy Roark

Dr. Andy Roark (05:30):
Sometimes I forget how I'm going to introduce you because I'm scattered and sometimes I'm too deep. I'm so deep I can't.

Stephanie Goss (05:39):
And yet none of this has, it does have to do with the episode, but it's not the episode. But this is going to be a good one. I'm actually really excited to dive into this one. So we had a letter from the mailbag, actually going to get started, you guys.

Dr. Andy Roark (05:59):
Alright, here we go.

Stephanie Goss (06:01):
We had a letter from the mail bag from Dr. FedUp and I thought that this was so great. So Dr. FedUp is a new grad that took a job at a privately owned practice that they thought that they knew very well. They thought they did their due diligence, knew the clinic, knew the culture, it's a multiple doctor practice and they actually have multiple locations. And this new grad asked all the right questions about mentorship and stuff during their interview process and felt like they were heading into a space where they were going to have strong support and strong mentorship. And they said on my third day of work, I got thrown into one of the practices. There was no other doctor present and I was scheduled with multiple surgeries. And this was the first of many issues that I've since had in this position.

(06:51):
Dr. FedUp says I love the team that I get to work with, but the mentorship that I was very clear that I wanted and needed does not seem to be happening at all. They are rarely scheduled with another doctor for appointments. And they've actually gotten to the point where they have refused to do surgery because more often than not they were getting scheduled to do surgery with no other doctors present. And they just didn't feel comfortable with that as a new grad. And so Dr. FedUp said, I'm now thinking about leaving, but I know that if I leave that there won't be enough doctors left to staff the multiple locations and that the practice may be forced to close one of the practices down. They have already lost another new grad before me for the same reasons that I'm now considering leaving over, which they found out after the fact it sounds like. And so Dr. FedUp's question is, how should I tell them that I'm leaving? How much notice should I give and how do I feel bad if they lose a practice and are forced to close a location because I choose to leave?

Dr. Andy Roark (07:53):
This question kind of made me chuckle when I read it and then we'll talk about why later on. But it was like, Hey, I have told them what I need and they have told me they're not going to give it to me. Should I feel guilty about leaving? And I'm like, no, no, I can't. No, there's a little bit more nuance to that and there's a number of different things that we can do, but the short answer is no. All you can do is tell people where you are and what you need and how you feel and be reasonable and rational and nice and then they're going to do what they're going to do. And you shouldn't feel guilty about that. And it's spoiling the end here. But veterinarians are very good at feeling guilty. We feel guilty about a lot of things. We feel guilty about working a lot. We feel guilty about not working a lot. We feel guilty about taking days off and about not taking days off. We feel guilty about all the things. Yes. And so we really champion this whole, I feel responsible and I don't know if I should. Yeah, let's dive into this. All right, cool.

Stephanie Goss (09:15):
Okay, so let's start. Let's roll back. We've spoiled. We've spoiled it and our end answer is no. We're going to talk through how do we let go of some of the guilt? And I think we have to start with as we always do with headspace.

Dr. Andy Roark (09:29):
And I'm not a hundred percent if this is just what's going on, I don't know that everything is lost yet. I mean maybe it is. We weren't there for the conversation. There's, I think there's a couple of very reasonable latch last dish efforts to try to pull this together and make it work that I think that there's a chance could succeed. So I think we should go in to hit those of trying to ride the ship a little bit, but then we're going to be very comfortable getting into the life raft and pushing off and it it's going to be what it's going to be. So anyway, alright, to your point, let's jump back.

Stephanie Goss (10:04):
Okay, so where do we start from a headspace perspective?

Dr. Andy Roark (10:07):
It is very easy to feel cheated if you are this doctor, right? Sure. To feel, I mean, just based on the story, I can imagine it would be very easy to feel like this is a bait and switch. I was told one thing and it was not true. I was brought here under the pretenses that'd be mentored and then that didn't happen. I got stranded by myself and then they put surgeries on my schedule knowing that I'm a brand new graduate and that's just dangerous and you're putting me in a place where my license could be at stake. It's very easy I think to spiral into some really dark thoughts about the situation. The first thing I would really counsel is the good old-fashioned assume good intent. I don't know. I doubt that there was an evil conspiracy to lure the doctor to the practice and then not do what he or she was told would be done.

(11:07):
I don't tend to, and again, a lot of this is what is helpful for you to believe. It's not helpful for you to believe that there was an evil conspiracy. What's helpful for you to believe is that everybody's doing their best and the practice owners probably thought they'd be able to hire more people. Maybe they thought that they would be able to get more staffing and that hasn't happened. They may owe money on the buildings and they're like, we have got to generate revenue here in order to avoid foreclosure. I have no idea. Neither do you. Right? I do not know what's going on their side of the table and I don't expect them to tell me at the same time, I don't know what's going on. All I can do is make decisions for myself and that's what I'm going to do. So I tend to say things like it's easy to forget what it was like to be a new veterinarian.

(11:59):
It's easy to forget how stressful it could be doing surgery on your own. If you were a very competent, capable new grad, it's probably really easy to forget that you are a brand new grad and just put stuff on your schedule. It's very easy for those things to happen. I think that these guys probably meant to do the things that they promised, suggested these guys, I don't know, I don't the gender of the mysterious owners, but it is very easy for ownership to forget what they plan, what they said, or to feel like we really want to do that. We simply don't have the manpower right now and we will get back to it as soon as we can. Again, it helps me just to assume good intentions and think okay, I don't think they tried to lure me here. The wheels seem to have fallen off on their side for some reason. It probably was not ill intent. They're probably doing their best. That doesn't really change the fact that it's not working for me.

Stephanie Goss (13:03):
Yes, yes, I would agree a hundred percent. And one of the questions that I asked myself to help with that, because as you said Andy it's very easy to get into the head space where you're imagining the evil bosses who are like, haha, screw Dr. FedUp. We're going to leave them by themselves and they're going to be left to defend themselves against the wolves. It's really easy to get into that negative kind of head space. And so one of the mental tricks that I use to combat them for myself is to ask what else could possibly be going on? What else could this possibly mean? And on the opposite side, hallucinate scenarios that could be going on for them, like you said, are they frantically trying to hire and they just can't compete with the corporate clinic down the street, are they or the big private practice right across the road?

(14:01):
Are they managing too many locations and are over their head financially? Think about some of those scenarios because it is way easier to take a deep breath and tap down some of that anger and frustration that you can very easily feel when you're not assuming good intent when you can put it into a little bit of perspective. And so I just like to hallucinate for a second for myself and I just ask myself, what else could be going on? What else could this mean? And explore some of the feelings and emotions that I have given to that, to how I'm feeling about it.

Dr. Andy Roark (14:41):
These hallucinations are not meant to change what you are going to do. No, they're just meant perspective to help you get a healthy perspective on who you're dealing with and how you approach it. And so ultimately I think they very much do change how we communicate, how we say things, how we articulate our needs because we tend to talk to diabolical villains differently than we talk to nice people who have bitten off more than they can chew and they're struggling. And so I think that we tend to be our better selves in the latter case, not in the former case. So yeah, start with good intent. The second thing that we talk about from a headspace is what is kind, and that is a big thing for me personally as sort of a non-confrontational person who has to have hard conversations. What is kind?

(15:36):
And the question was really do I tell them how I'm feeling? What do I say to them? Is it okay that I feel this way? And I would say to them, what do you think is, is it kind for you to not say anything and just go get another job? Or is it kind for you to communicate, Hey, this is what I need to continue to work here and feel like I'm growing and be engaged full stop and give them an opportunity to try to provide me what I need before I go and find something else. I would say the kindest thing is to give them the opportunity to try to give you what you need. So when I think about that, what is kind? I go, yeah, my natural default tendency early in my life was very much not to say anything and then to leave, right? Sure. And that's just where I have grown to a place where I realize that that's not the kindest way to go about it because I tend to, people would end up kind of blindsided and they were like, I, you're leaving and we had no idea and we don't know how to fix this now. And had I said early on in clear and kind terms, Hey, this is what I'm struggling with and I want you to know that I'm having a hard time with this and it's making me stressed out regularly and just leave that.

Stephanie Goss (17:06):
Yeah, I think that's great. And on the flip side of the kind coin, I would ask what is kind for yourself? And this kind of bleeds into the point we were making earlier about the spoiler alert. You shouldn't feel guilty and you have to give up some of that guilt and the responsibility that you're taking on there. And I think the easiest way to do that is to ask what is kind to yourself? Is it kind to yourself to make yourself feel guilty and like you're responsible? Hell no. Cause it is not your circus, not your monkeys. The kinder thing to do is to say, this is what I need and this is what I'm not getting. And if somebody doesn't give you what you need, when you have been very clear and kind in asking for it, why would you feel any guilt or responsibility? It becomes immensely easier to walk away when you have been able to advocate for yourself clearly in that way. And so when I think about what is, I also think what's the kind thing for myself and being able to be very clear is going to give me some of that absolution that I'm looking for.

Dr. Andy Roark (18:19):
Oh no, I love that you say that. I think that is so true. I think the path out of feeling guilt when you leave is to advocate for yourself before you leave. I think a lot of the guilt comes from should I have said something differently? Should I have stayed? What if it gets better later on? What if there was something that I didn't know that they didn't tell me? Yes, almost all of that can go away if you advocate for yourself early on and say, Hey, this is where I am, these, this is what I need to change. And then you can say, I told them all of these things and they knew where I was. They had the opportunity to tell me anything they wanted to tell me. And then they elected to not make these changes or provide these things. And to me that is the key to dropping the guilt is saying, I gave them all the information to make the choice and they made the choice. And so now I'm not going to feel guilty because I told them what was going on. And so to me, and I also love the point you made about when I say what is kind, I am talking about what is kind to all of the affected parties. So in this case I would say, what is kind to the employers? What is kind to you? And also I tend to add in my family, what is kind to my family? Does this work for them?

(19:44):
How disruptive is it for me to uproot and go somewhere else? I'm going to factor that in. I'm not saying I'm going to stay necessarily, but I do want to weigh what is kind to my spouse or my significant other or my kids or whatever, I want to weigh all that stuff in. So all that should factor into what is kind. And then I really come back around to the same place that you do is if you walk through the exercise of I'm assuming these people are good people and they're trying hard and I want to be kind to them. And so I'm going to communicate to them clearly and honestly and candidly where I am, what I need, how I'm feeling, where I am, what I need and how I feel. Then after that, I need to step back and realize and recognize and hold on to the fact that this is not my responsibility.

(20:35):
Meaning no one, no one gave you ,fed up vet, the power to run the practice, right? No one gave you the power to make any changes to what's happening. And so how in the world can you feel responsible? And we talked about this before and it's just been something that I have been thinking a lot about. Veterinarians feel responsible for so many things and the working tool that I'm using right now is the three questions. Did you create this problem? Do you want this problem? And do you benefit from this problem? And if you didn't create it, you don't want it and you don't benefit from it, then I don't think you're responsible for it. And I think that you need to say, that's it. Not my circus. It's not my monkeys. I am not responsible for this. That doesn't mean I don't want to try to help people.

(21:23):
It doesn't mean I'm throwing up my hands, turning my back on people. But as far as me feeling responsible, nope, I didn't make it. I don't want it. I don't benefit from it. Yeah, I'm not responsible. And so that's it. I guess the last part is our friend Phil Richmond says Honesty without empathy is cruelty. And I like that a lot. And so I am going to have a kind, honest conversation with these people. And again, a lot of this, this that's really easy to be honest and empathetic. If I assume good intent, honesty without empathy tends to come when we don't assume good intent. And what that sounds like is people are like, I'm just going to tell 'em, I'm just going to 'em straight out. This is what it is. You can speak the truth and still be rude. Yes, you can speak the truth and still be hurtful. You can speak the truth and still damage relationships and burn bridges. Speaking the truth doesn't absolve you of how we impact other people. And so I am going to speak the truth, but I'm also going to try to do it with empathy and again, assuming good intent. So that's sort of the headspace I guess for me going into this.

Stephanie Goss (22:32):
And I think to that point, one of the reasons why it's hard in the final, I'm going to leave conversation for people to be candid with empathy is that I think a lot of people think that being empathetic means that you have to let what you hear back from the other person affect or change your decision. If I'm empathetic to them and they say, well, we had another vet quit and this is not our fault. I think a lot of people think that empathy means that they have to change because of what is shared with them. And I think that's a mistake that a lot of us made. It's really about being kind and understanding. I can totally understand that and I'm not angry at you guys. I appreciate the opportunity that you gave me as new grad and this is not working for me.

(23:28):
Yeah, I'm going to need to move on. That is very different than giving them the feedback, having them give you reasons why and saying, okay, I guess I'll just suck it up. That's the wrong move too, I think is middle ground where you might hear information and your empathy may lead you to say, maybe I didn't give this a fair shake. Maybe there can be a, maybe there can be a middle ground here. Maybe we can try something different. And if not, that's okay too. But I think that the empathy part comes in giving the information and then just listening and receiving that information with grace. It doesn't mean that you have to change what you're going to ultimately do or the decision that is right for you.

Dr. Andy Roark (24:16):
The difference in emotional empathy and cognitive empathy. And this is a top, this is a concept I've been playing a lot with recently because I feel like it's really valuable and I need to figure out how to weaponize it and use it on vet professionals. But the basic idea goes emotional empathy is sharing the feelings of another person. You know what I mean? Cognitive empathy is understanding their position and where they're coming from. And I think often when we say empathy, people jump to emotional empathy. And guys, I think we may overuse emotional empathy and we may need to adjust a little bit more towards using cognitive empathy. So think about in the exam room, if you're an empath and you lean into emotional empathy, you're going to have just the craziest emotional day. Yes. Because you are feeling the joy of puppies and the sadness of the euthanasia and the fear of the surgery and you're feeling all of these things.

(25:18):
And I go, gosh, that's exhausting and I'm not convinced this really necessary. I think we want to understand the joy of the pet owner and support it and understand the sadness of the person losing their best friend and understand the fear. But think about if you were going for surgery, you don't want your surgeon to be having emotional empathy, but the surgeon's, I'm terrified of, this is really scary stuff. I'm not going to lie. I'm feeling it. I don't want, I want my surgeon, I do not want my surgeon to share my concerns, my and my fears and my anxieties at emotional level. I want them to understand how I feel and be very aware of my fear feelings, but then I want them to go on. And so I think that especially when we start to have these conversations with the employers and we start to say, I want to be empathetic, that doesn't mean that I'm going to get snowballed here.

(26:12):
You know what I mean? And just sucked up into their narrative and go, oh my gosh, I'm so sorry I even brought this up. Like, no, I understand. I am here and I'm listening. I'm really am understanding and trying to understand, and there may be things that make me change my perspective or change my ideas about what is reasonable or why these things happened. And so I'm a hundred percent open to growing my perspective. I mean, that's why we have the conversations. If you're going to a conversation and you're not open to changing your perspective, what are you doing? You're going into monologue is what you're doing and wait quietly while the other person talks so you can continue your monologue and that's not productive. So yeah, so emotional versus cognitive empathy. I'm very much leaning into the cognitive empathy here of help me understand what's going on, how you see it, and I want to learn at the same time while I'm being empathetic to your position, I still need to at least communicate my position to you and see if you're empathetic. And if I'm empathetic to you and you're not empathetic to me, that's that's going to be a hard relationship to make work.

Stephanie Goss (27:13):
So I have some ideas on how to approach this because I think both you and I agree that there may be opportunity to talk this through and make some changes that may move Dr. FedUp into a better position. May not. But if they haven't given up hope completely, I think that there are definitely some solid steps that they can take before we tackle our spoiler of don't feel guilty. Hey friends, I want to make sure that you know about an upcoming workshop that you're not going to want to miss. And I know I say that about a lot of our workshops, but I mean it about this one. Well, I mean about all of them, let's be real. But this one holds a special place dear and dear to my heart. Two reasons, one, my friend Dr. Jen Quamen is leading the workshop. Number two, it's about technology.

(28:03):
And if you've listened to the podcast, what a techno nerd I am. I super excited to have Jen with us. Thanks to our friends at Teve. She is going to be talking on May 24th at 8:00 PM Eastern, so 5:00 PM Pacific about trending technology in the veterinary space. Now, I love technology. We've talked about it on the podcast. We've had guests on the podcast. And one of the conversations that has been going around and around in a lot of the groups I'm in lately has been about chat, G P T or artificial intelligence ai. And so if you've ever wondered about using AI in your practice or if you have wondered about wearable technology for pets, communication tools and techniques that use artificial intelligence or advanced technologies, those are the kind of things that Jen is going to dive into during this workshop because most of us have wondered when we've talked about those technologies, if they actually will save us any time or energy or if they're just a new trend. So Jen is going to dive into some of the things that have come to market, some of the things that are actively being used in veterinary medicine that you might not know about, and ways that we can incorporate technology into the veterinary space in a way that works with us and not against us. So if this sounds like something that you'd love to get in on, head on over to the website@unchartedvet.com slash events to find out more. We'll see you there. And now back to the podcast.

Dr. Andy Roark (29:34):
All right, let's get into some action steps here. I think we talked a lot about kind of how we feel about this. Okay. What does this conversation look like, Stephanie?

Stephanie Goss (29:43):
Okay, so for me, before we get to the conversation where Dr. FedUp says, I'm done, I quit. Yeah, if is there's anybody else in a similar position to Dr. FedUp who does feel like there's potential to salvage the relationship? Or to your point, Andy, if you are the person who, when you think about what is kind to your yourself and the people in your life, if you're in a position where it would be a big, big problem if you had to move clinics because there isn't another one for 60 miles from your whatever, if you're in a circumstance where you really want to try and make things work in your practice, then I think that there's a few things that are very clear and very kind to try and work through for yourself. And the first one would be I think that especially as a new grad, I think you need to define your expectations for yourself.

(30:37):
Because to me, if you can't write them down and you can't articulate them for yourself, you can't expect anybody else to understand them and let alone meet them. And what I mean by that is as manager, I have worked with a lot of new grads and one of the things I've struggled with in recent years is that I appreciate the vet schools are teaching the students about the concept of mentorship and practice. And yet I will tell you as a manager in part of my interview process, I can count on two hands the number of new grads that were actually able to tell me what mentorship looked like or should feel like for them personally. Far more of them just were like, well, I want mentorship, but when I asked questions, they were absolutely unable to explain what that meant and what they actually wanted. Because mentorship can feel radically different and look radically different for different people as it should because it should be very personalized. And so I think the first step for me is if you are Dr. FedUp or you are a new grad, you've got to be able to define it for yourself. So this is self-reflection 101. Now

Dr. Andy Roark (31:50):
I completely agree with that. I think there's a couple things in vet schools especially, but then also just in our professional in general. I was listening back, I was listening back to a podcast that we did recently just a couple weeks ago, and it's actually one of my favorite ones we've done in a while. I really liked the vet who won't go home. I like that for people who are going to talk to vets who won't go home, and for people who are vets who won't go home, I really like it. But we touched on this there as well. I think that there are a couple of phrases that we have elevated in vet medicine for good reason and good, but we've taught people the words, but the words don't provide clarity enough to be actionable. So we talk about work-life balance, we talk about mental health and we talk about mentorship and everyone knows those words. And we've done a good job of selling people on the importance of those concepts. And I think that, and again, present company included, we talk about the importance of those things all the time, but I don't know that we as a profession or as individuals have done a good job of crystallizing those concepts into requirements, action steps, line items in the company handbook.

(33:04):
So I think that you hit the nail on the head with that is when I say, Hey, I need mentorship. When you say that to me, I have no idea what you mean. And again, and I love mentorship and I'm talking about mentorship all the time. I have have literally a 50 minute lecture I do on mentorship. I have no idea what you're talking about when you say mentorship to

Stephanie Goss (33:19):
Me. Yeah. Because it can mean such radically different things to me. It could mean I want you, Andy, to work with me on every appointment that I do for the first three months because I want you to coach me and tell me what you would do, and I want to talk back and forth. And for another person, it could mean I want to have once a week check-ins just so I can ask questions. Those two things are radically, fundamentally different. And if you have no idea what that means for you, you are setting yourself up for failure regardless of what your environment, also, how your environment also plays into that. So if you can't define it for you, how are you supposed to hold your bosses and your team accountable for delivering it for you? If you can't explain to them what that looks like,

Dr. Andy Roark (34:06):
And I want to be realistic about this too, I don't know that's ever going to be possible that a brand new graduate was going to come out of school and say, this is exactly the mentorship that I need at the frequency that I need it. I didn't have that self-awareness at all. I had no idea what I was getting into. And so I'm not saying, Hey, new grads, you should walk out the door and have a mentorship schedule. No, you should go in with an open heart and mind and say up front, Hey, mentorship is really important. I want to make sure that I'm supported. We're going to have to see what do you guys usually do? Do you have a program for that? Have you done this with other grads? What worked well for you? Yes, I want to ask all those questions, but ultimately the idea for me is let's get in there and see what we're looking at.

(34:47):
And if after two weeks I feel completely terrified and overwhelmed, I'm going to need some handholding. And if I get in there after two weeks and I'm rocking and rolling, then maybe we'll have breakfast every other week just to talk about practice in general and kind of where things are going in long-term skill development. But I'm not going to know which of those I need until I get in there. So no shade to our fed up doctor who's like, I'm not getting what I need. And I didn't communicate that clearly to them at the beginning. I don't know how you would know at the beginning, but I would say that now you're at a place where you can say, this is what I need. We talk a lot about having conversations in our sort of safe acronym. The F is has this person been set up to fail and what here is my fault?

(35:33):
And so sometimes I hear vets complain that they don't get mentorship and they're complaining about the practice owner. And the practice owner has been set up to fail, meaning they don't know what is needed or required. And so in that way, they've been set up to fail. The reason that we think about these things is not so we can bash people or hold court. The reason we think about it is because it can be a very effective communication tool to say, Hey, I'm coming to a place where I'm pretty confident in what I need. And I can articulate that now. And I think when I was getting started, I didn't really know what I needed, but now we've gone enough, we've gone far enough down this path that I can say pretty clearly what the support that I'm going to need to be successful given what you guys are trying to accomplish. And that feels really good, I think.

Stephanie Goss (36:23):
Yeah, no, totally. And so I think to your point, I would not expect a new grad out of school to have all of that, the ability to say, this is what I need because you've never had a job as a vet in a clinic. So how would you know Dr. FedUp is in a position where now they've been there. And so I'm going to use an example that they gave us, which is that clearly they're really not comfortable with doing surgery by themselves. That's a really clear, easy example, concrete. Cause step number two for me is you have to make a list of all of the gaps and be clear and concrete with your examples. So for Dr. FedUp, if being in surgery alone is a deal breaker, then that's a great example. You can tell them not only what it is that you're uncomfortable with, but why it makes you uncomfortable.

(37:11):
I don't feel confident being in surgery about myself because whatever your reason is, if yeah, and the ability to say, I don't need another surgeon in surgery with me, I just need to know that someone's in the building. If something goes completely sideways, whatever it is for you, that is upsetting and that's going to be different in an individual. To be able to give that clear definition is so, so important because then the third step for me is you have to be able to tell them what is the impact. So for you, how does that make you feel? But also what is the risk for your patients? I could very easily hallucinate that Dr. FedUp is worried that if they're doing surgery by themselves and there's no other doctor on the premises, that if something goes sideways that they're worried that their patient could die because they don't have a lifeline, they don't have a phone to friend.

(38:06):
They don't have somebody who they feel like could jump in and help them. And if I was a practice owner and I was hearing someone tell me that that was their concern, that's smacking them in the face with a board. You got to be really on tooth to not understand why that should be a problem. If you are a practice owner, your patient care should be important to you and you should be able to say, oh, duh, I get, that would be crystal clear to me as a practice owner when somebody is telling me not only what is the clear and specific example, but also how is it impacting themselves, their patients, the team, the clients, whichever one of those things or multiple things are being impact that should matter to a hospital leader.

Dr. Andy Roark (38:54):
Yeah, and I agree and we know the power of because, right? There's just a fundamental difference in me coming in and saying, I need to have morning rounds with another doctor every day and me coming in and saying, I need to have morning rounds with a doctor every day because something, and there's a lot of resources shows that honestly, because something doesn't matter nearly as much as the fact that you said the word because and gave a justification for what you need. And so being clear about your requirements because, and then give it some weight, give it a consequence, give it some value for if they decide to come along and support you.

Stephanie Goss (39:39):
And then the next step after I ask for what I need, the next step for me would be to ask for clear to ask them for their help and get clear expectations. Like from a smart goal perspective, this is your opportunity to figure out what is reasonable and what can you expect and ask them for what they need and if they agreed to it, because when you interviewed, you felt like they were agreeing that you were going to get mentorship. If you have now defined what mentorship means to you, you've explained to them why it's important to you, you've given them a clear concrete example. If they are agreeing to provide that to you, this is where you need to write it down. It isn't a contract. You're not writing it down to be able to point fingers or lay blame, but you want to eliminate the shades of gray. And by writing it down, you can use that for me as a tool to say, we had this conversation, we wrote it down, feels very black and white. You agreed that there would be somebody on the premises when I was doing surgery by myself. It's now been another two weeks and every single day I've been by myself, I have zero guilt walking away from that conversation. If I have made it clear and I have written it down and they have agreed to it,

Dr. Andy Roark (40:58):
This is often. So we're sort of walking through what we want to accomplish. And I agree with everything that you're saying and how you lay this out in the spirit of setting expectations, know that this might not all be in one conversation. You know what I mean? Especially when you're talking about mentorship. For example, I go to the manager, I go to the practice owner and say, Hey, I need to have a doctor meeting every morning for Dr rounds and blah, blah, blah. They don't know if the other doctors are going to want to have this meeting. You know what I mean? Or can I get a mentor and who they often would say, I don't have the power to commit Dr. So-and-so to meeting every morning and maybe he'll do it, but we have to at least ask him and include him in the conversation.

(41:38):
And so I think that's very, very understandable. I think he absolutely go through these steps. Just recognize I don't want anyone to go into the conversation and be like, here's what I need and here's the consequences of me not getting it. Meaning as far as the fallout for the downside for the practice, and here are my goals and here are the deadlines that I expect to have met. I think you'd be looking at some blank faces who are like, we have no idea if any of this is feasible. We have to sit with this a little bit, and we have to look at the schedule. We have to figure out what's possible. And so I would just say in setting expectations, this is going to be probably more than one conversation. And that's fine.

Stephanie Goss (42:15):
Absolutely. And that for me was where I was going was the last step, which is what is the timeline? So are you asking for something that is going to require involvement from other people, schedule changes? Look, if you were telling me that if I was the practice manager and Dr. FedUp was having this conversation with me, I'd say I hear all of that. Yeah, I am committed to working on this. I am commit. I feel like we can solve this. I need some time. And it would not be an unrealistic ask for Dr. FedUp to say, what does that timeline look like for you? Because they have a right to know, are we talking about we're going to try and change this in the next two weeks or are you talking about someday in the future there might be a doctor here? Because you're not wrong to feel like if doing surgery alone is a deal breaker to you.

(43:03):
And you tell me that as a manager and I'm like, okay, I think I can juggle things around, but for the next month you're going to have to be on your own because I don't have another doctor starting for a month. I would be understanding if you said it's a deal breaker for me, no, I'm not going to do it. And maybe we could still come up with a compromise. Maybe we just don't do surgery for the next 30 days. And maybe that's something we both could agree to, or maybe Dr. FedUp says, I can't wait 30 days. I'm sorry. But then we both sides know. And so the last piece of it in terms of being clear and kind for me is what is the timeline and what can we both agree to here? And then really both sides holding each other accountable so that the deadline doesn't come and go and that resentment start to fester on either side because you haven't circled back to it on the timeline that you both agreed to.

Dr. Andy Roark (43:54):
Yeah. I think this is a great outline for the conversation. I also think you're asking the questions that are pretty clear questions and if they say, when you say, what is the timeline? And they were like a month, I'm not saying you should do it or you should not do it, but at least you have some sort of timeline to talk about. And if a month comes and goes, you can say, you said it was a month and here we are, but all of these things are moving that conversation forward in a productive way. And then also from a guilt management way. Yes. Because if you've walked through these conversations and you said, I told them and they said it was 30 days and then nothing changed, and now I do not feel guilty about leaving. I told them what I needed. They gave me a deadline and then nothing happened. And all of those things are good peace of mind for me. And no one could ever say, Andy didn't communicate, he just bailed. He just quit and found another job and bailed. No one would say that. And I'm not going to say it to myself.

Stephanie Goss (44:57):
Yeah, no, I totally agree. To me, when I was thinking about it and laying it down for myself in prep for this, I thought if you do all of those things and you still don't have your expectation met, why would you feel guilty? Why? Yeah. No,

Dr. Andy Roark (45:12):
I love it.

Stephanie Goss (45:12):
Clear. Clear is kind. You've been clear. Move along. And so I think that brings us to then if you are moving along, what do we do? Or if you're Dr. FedUp and you have no interest in salvaging things because to you it has gone too far, I think Dr. FedUp had asked us three questions which were, how should I tell them that I'm leaving? How much notice do I give and do I feel bad or guilty if they lose a location or a practice because you choose to leave?

Dr. Andy Roark (45:45):
Yeah. This is always an interesting question. People ask me what to tell them, and my answer is not always very popular. And so I'm going to let you answer first and I'll tell you what I tell people, and then you'll immediately be like, oh, I see why people don't like that.

Stephanie Goss (45:59):
To me, this is where clear is kind professional matters, and I don't want to burn my bridges. I always write, and I can tell you this from personal experience, because I have been in this position, I was at a clinic, I gave very clear feedback about things I needed to change. I gave a timeline. The timeline came and went and things were still the way that they had been before we had the conversations. And I said, okay, I'm done. So when I wrote my letter, I said, thank you very much for the opportunities. I have really enjoyed being able to serve the team and the clients at this location, and I wish you guys the best of luck. And then when I had the conversation verbally with them, I said, this is the feedback, this is my why, and I'm sorry if that feels hurtful. I'm sorry if you don't agree with it. I don't really have anything more to say, but I gave them very clear feedback verbally. I chose not to put that in my resignation letter because I do believe that giving a resignation letter, having it be professional, helps you from burning those bridges.

Dr. Andy Roark (47:08):
Yeah. Yeah. What I generally say is, when it comes time to hand in your resignation, I get real selfish in that. I think to myself, what do I want to accomplish in this conversation? What am I trying to do here? And the answers from me are, I want to, in this relationship, I want to do the best that I can to protect my reputation and to not burn bridges because this is a small profession and I move forward with those three. Those are my three objectives. What my objective is not to make the other hospital better, assuming that I'm leaving because I have been clear about what I needed. I'm not getting the mentorship and blah, blah, blah. It's not my job to fix your hospital.

(47:53):
No. There's a risk to me of giving feedback as I leave about here's why I'm leaving. Sure. And there's no reward. And so people really don't like when I say that and they say, but you should use is your chance to give them feedback that maybe will get heard. I think where I would come back around is to say, context matters. If I have done the things that you and I have talked about on this podcast, meaning I have communicated what my needs were and I said, this is what I need to feel comfortable, and those things have not happened, I don't think I have to spell it out in an exit interview or in my letter of You've already given it. I have. Right, exactly. Yeah. I say I have given the feedback and at this point I'm leaving. And my priority shifts from trying to get them to hear the feedback.

(48:41):
Two, protecting my reputation, making sure that they're not going to tank other opportunities that I might come across Sure. In the future. Because again, it's a really small profession and who knows? I said, it's incredible. It's a small profession and you do see people all over the place. And so your manager, now that you're leaving, may he or she might be your manager again at some point like it's right. It happens. So anyway, I get into that and so the context matters. Have I given them feedback getting up to this point? And the answer is yes. Then I've already given the feedback and I'm just a hundred percent trying to salv, maintain as much of the positivity of our relationship as I can as I depart. And then again, this is just breaking up. 1 0 1 is I want to make the other person feel as good as possible just because you never know when your path will cross again.

(49:40):
And so let's try to make this as amicable as it can be and I'm going to go my way and you go your way and that will be that. So I don't know, I guess that's a big thing. The other part of the context for me is what is the relationship that I have with this person? And so if I really feel like the manager went to bat for me and said, Andy, I really, I told you that we would get these things. I am very sorry that they have not been provided. And I want you to know that I totally understand where you're coming from and how you feel. I'm a hundred percent open to having a conversation with that person because I don't feel that my words are going to be used against me. And if they want to ask me things, then I will help them because we have a good relationship and I feel like it's beneficial to my friend. I would do that. I would still agree with you. I'm wary of putting those things down on paper, especially as we start to get into an age of corporate practices and things like that tend to stick around and they may get pushed up the chain or go to other people who don't know me personally and are only seeing these things. That's kind of how I think about how to tell them that I'm leaving. Yeah,

Stephanie Goss (50:48):
Absolutely. And then, so the next question was how much notice do I give in it? It's interesting cause we were talking about this in the uncharted community recently and my answer, my answers, what does your contract say? So for a doctor, that's where I would start. And if your contract doesn't have specific notice guidelines, which would be shocking in this day and age, then I think the debate comes over. The idea of giving two weeks notice and two weeks notice is professional. I think my personal opinion is two weeks notice is professional for a paraprofessional role in a professional role like a veterinarian, a manager. My personal opinion is that four weeks is professional because realistically they're not going to fill the hole in four weeks time, but four weeks at least gives them a chance to put some finger on the bleeding hemorrhaging wound.

(51:46):
Like you know, reshuffling a doctor's schedule is a lot, especially in this day and age where we're booked six to eight weeks out. So if you give me four weeks notice as a manager, that is something that I can work with and that I can a appreciate. And if you're in a position where you can give more than four weeks because you're leaving on what good terms, great. But otherwise, I think four weeks is good because four weeks is a long freaking time if you're already fed up. And it is very easy to shift from a positive headspace to a very toxic headspace in four weeks.

Dr. Andy Roark (52:25):
Yeah, it was an interesting conversation. Uncharted, I think my takeaway was for doctors, the consensus was four to eight weeks, kind of what was it? And I think most of the people in the conversation we're practice owners. So I think we were seeing it on very much on their side of what do you think is good when someone is leaving your practice? And so know that that's kind of the group of Yeah, exactly. So four to eight weeks was kind of the consensus that people put out. And I get that it is very hard to replace people. Now, to me, again, it does go a little bit there. So first of all, what's in your contract? That is the key. And there we've the Kona Shame podcast that I do, I've got a great episode with Lance Rosa, who's a vet and a lawyer, and he talks about, the episode was on sort of new doctor employment contracts or what's new in doctor employment contracts. He talks a lot about termination clauses and there is a lot of stuff going into them now. A lot of the corporate groups have their legal departments who have gotten the memo that vets are really hard to replace. And some people are seeing six month notices you're supposed to give six months notice before you leave. And that's in the contracts

Stephanie Goss (53:39):
Absolutely insane.

Dr. Andy Roark (53:41):
I completely agree. But know that those things are out there. Oh yeah. Hopefully this is not news to you when you try to leave, you go, what? Six months? That's not the time to find this out. So I hope that you picked up on that before you signed the contract. But go look at your contract and see what's there beyond that. And honestly, if you're having these thoughts, that podcast is really great because I asked Lance, what happens if I just leave and we get really into that rabbit hole, which is fun. Yeah. So good stuff to know. What does your contract say? And then Ellen, that the other thing I sort of add into the mix a little bit is what do you think is going to happen after you give your notice? Sure. If you think that this is going to be become a toxic hellhole place to work for you, then I might lean closer to four weeks.

(54:31):
And if you think these guys are generally really cool, and I do really like the manager, I feel like he or she has gone to bat for me again and again. I don't want to leave him in a lurch. I'm not wildly unhappy, but this situation is not getting better. And so I'm going to go, I found another place where I think it's going to work better for me, but I'm going to try to make my exodus as easy on you guys as possible. Then I may end up trying to stay a bit longer. So anyway, I think all those things factor in as, again, context, how you feeling? How do you think you're going to be treated? How do you think this is all going to go down? But four to eight weeks is probably what I generally hear these days.

Stephanie Goss (55:10):
And then the last question was, should I feel bad if they lose a practice because I leave and we spoiled the hell out of this one, but hell no. Yeah, no, this not, your circus is not your monkeys.

Dr. Andy Roark (55:27):
You can'y feel this way. I mean, to me this is, well, this is exactly, this is comparable to you trying to get a pet on her to take home flea prevention repeatedly and they won't do it, and then their pet gets fleed. Do you feel responsible about their pet having fleas? Well, no, I, I told you five times that your pet should be on flea prevention, or in a worse case, heartworm prevention. I can't make you buy this and give it to your pet. Yeah, same thing with the practice. I can't make you do the things that you don't want to do. All I can do is be kind and articulate to them, Hey, this is how I feel. Maybe other doctors feel this way too. I don't know. You might want to check. All I can do is put that stuff forward, you know, lead a horse to water. I can't make 'em drink. And if the horse falls over from dehydration, I mean, I did my best and now I got it. Now I got to go on.

Stephanie Goss (56:24):
Well, and I'll go one step further and say to Dr. FedUp or any doctor who is in this position, the reality, and this is going to maybe sound harsh to some of my managers, but I'm going to drop it anyways. It isn't your job as a doctor to manage their business. That's the manager's job, that's the practice owner's job. And if they succeed or fail in their job, that is a hundred percent on them. That is not on you. And so I could absolutely go to sleep like a baby at night knowing that if I did the things that we talked about here, I would feel zero guilt walking away. Yeah. Because that's not your job. You're a vet, your doctor.

Dr. Andy Roark (57:13):
The only way I can feel any guilt about this at all is if I do not communicate my needs correct to them in a way that they could address them and that that's it. Like, but that's a big box for me. And a lot of people don't do that. They get frustrated. They don't really go and have the serious conversation of, Hey, I just need to talk about how things are going. Yeah, totally. They don't do that. And then I think that there's a, there I could a hundred percent see wrestling with guilt then, because I did, especially if they were surprised that I left. I can see some guilt there. The same thing on the other side. As the manager, I a hundred percent understand guilt in letting someone go if they're surprised to be let go. And we've talked about that. Yes. In a number of other episodes, if something is really not working and someone is not making the cut, I really don't want people to be surprised when they get let go from an organization. Yeah. I feel like they should a hundred percent see it coming, and if they don't see it coming, I didn't do my job, then I do wrestle a little bit with guilt because I'm like, did I not, I not explain this? Did I not? Was I not open enough about, you know, was I not clear and what expectations were like, I feel like I own this if they're surprised going out the door.

Stephanie Goss (58:31):
Yeah, totally. Totally. Oh man. Anyway, this was really fun. Life lessons from the garden.

Dr. Andy Roark (58:41):
I was going to say. And that's how sometimes we have to do pruning life lessons from the garden with Dr. Andy.

Stephanie Goss (58:48):
Oh man, I love it. Have a great week. You guys. Take care.

Dr. Andy Roark (58:51):
See you gang.

Stephanie Goss (58:53):
Well gang, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mail bag and answer this question. And I would really love to see more things like this come through the mail bag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mail bag at the website. The address is uncharted vet.com/mailbag, or you can email us@podcastunchartedvet.com. Take care everybody, and have a great week. We'll see you again next time.

(59:36):
Hey, are you guys using wifi still? Can you guys get off the wifi for another 20 minutes until I'm done? Because it's really glitchy. Thank you.

(59:52):
Okay. Dustin's going to have so much fun editing this episode.