This week on the podcast…
This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are picking up where they left off last week! That's right, this is part 2 of our first cliffhanger episode (click here for Part 1). This week, we will dive into the action-step ideas for the challenge facing our repeat mailbag writer who was previously feeling squashed and stubborn. They are still at it and just as stubborn as ever, only this time, they are struggling with not letting client frustration over scheduling woes get them down. They are booked pretty far in advance and doing all the things they can to manage the schedule and clients are still really frustrated. They are voicing it to the team and it is starting to crop up in online reviews this doctor is asking for help in getting into a good headspace and not letting it get them or the team down. And also looking for help on how to communicate to clients that they have to wait and why it's okay to wait in some cases, without clients feeling brushed off. Let's get into the action…
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Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag
Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.
Upcoming Events
Pay Scales And Wage Transparency with Stephanie Goss
Recent law changes in multiple states and more coming down the pipe January 1, 2023 make pay scales and wage transparency an urgent matter for all veterinary practices to consider.
Date: November 20
Time: 4-6 PM ET – 1-3 PM PT
The Secret Sauce to Optimizing Workflow with Senani Ratnayake, RVT
Back by popular demand! It's time to take a look at the workflows that aren't working and come up with a plan to move forward with a strategy that makes sense.
Date: November 30
Time: 5:30pm ET/2:30pm PT – 7:30pm ET/4:30pm PT
All Uncharted Veterinary Community Workshops are LIVE! You will be able to ask the instructor questions that help you address your practice’s unique problems. This will not be 2 hours of silent screen time. Gear up for interactive, fun learning!
Episode Transcript
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Hey, Stephanie Goss. You got a second to talk about Guardian Vets?
Stephanie Goss:
Yeah. What do you want to talk about?
Dr. Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing.
Stephanie Goss:
Yes.
Dr. Andy Roark:
And I'm sure you hear from these people as well, “Our caseload is blowing up and the doctors are busy and the phones just don't stop.”
Stephanie Goss:
They never stop. That is a true story.
Dr. Andy Roark:
I'm amazed by how few veterinarians know about Guardian Vets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and Guardian Vets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.
Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well, which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls and so we talk about it. We've talked about Guardian Vets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”
Dr. Andy Roark:
Guys, if you're not familiar with Guardian Vets, if you think that you could use some help on the phones or up the front desk, check them out. It's guardianvets.com. And if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardiansvets.com.
Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted podcast. In fact, this is Part 2. This is the second part of last week's episode where we started talking about feeling overwhelmed, but not wanting to give up. We tackled head space last week, so if you missed the episode, go back and listen to number 204, so you can hear what Andy and I had to say about how do we handle feeling overwhelmed about a certain issue in practice, but not wanting to give up on it.
This is a repeat writer from Squashed But Stubborn and we really appreciated their question about how do we manage it when our clients are frustrated that we can't get them in. And they're letting us know and we are doing everything we can to help them out, but it's still not fast enough for them. And now, maybe some of them are communicating it to the staff, but also leaving online reviews and it is hard to not let that get to you. So, Andy and I spent last week talking about head space and this week, we're going to dive into some of the action steps for how do we handle it when we feel overwhelmed. Let's get into this, shall we?
Speaker 3:
And now, the Uncharted podcast
Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie “Taking You to the Streets” Goss. That's right. We're taking it to the streets. That's right. It's taking it to the streets because this is an all-action episode.
Stephanie Goss:
Yeah.
Dr. Andy Roark:
If Arnold Schwarzenegger made a veterinary business podcast, it would be this podcast. It would be this podcast.
Stephanie Goss:
I can't. I can't.
Dr. Andy Roark:
We managed the practices in an aggressive way.
Stephanie Goss:
I can't.
Dr. Andy Roark:
You will set boundaries for yourself. Get ready, crash cart. All right. I could have ended this thing. This is the best thing that has happened to this podcast.
Stephanie Goss:
Oh, God.
Dr. Andy Roark:
I know. That's if Arnold was slightly German.
Stephanie Goss:
Right?
Dr. Andy Roark:
That was. And much, much smaller.
Stephanie Goss:
Much, much shorter.
Dr. Andy Roark:
Much shorter, yeah.
Stephanie Goss:
Much less muscles.
Dr. Andy Roark:
Less impressive, yeah. He's like Mr. Universe.
Stephanie Goss:
I mean, it is almost Halloween.
Dr. Andy Roark:
I'm like Mr. Corner.
Stephanie Goss:
That could be a good… that could be a Halloween costume for you.
Dr. Andy Roark:
Oh, and I would… I mean, what do I need to do? Take my shirt off. That's it. Done.
Stephanie Goss:
Andy Arnold.
Dr. Andy Roark:
Yeah. It's like-
Stephanie Goss:
Same thing.
Dr. Andy Roark:
Same thing. Oh, my God, I thought you were him. Yeah, I get that a lot.
Stephanie Goss:
Oh, my gosh. If you're tuning in, you're like, “What are these two going on about today?” We're back. This is going to be totally different for us. This is Part 2, our last week's episode. We got to the end of head space and said, “You know what? Rather than give you guys marathon episode, we are going to break this into two.” And we are going to tackle the action steps next week because there's some really good ones and we want to dive into that. Andy, do you want to give a recap of what we started off with last week in case anybody missed the episode?
Dr. Andy Roark:
Yeah. Yeah, I do. So, let's go ahead and talk about the… we got a letter from the mailbag. And we have a veterinary practice owner who is trying not to burn out. Yes, she is overwhelmed with cases. She has lost… I'm saying she. I don't know if it's a she. It's just a guess. She's lost half of her technician staff in the last year and two and a half doctors this year. Only, it's two and a half because one of the people retired and has come back.
She can't get her regular clients in and she's really bothered because she can't get clients in who need to get seen. And they're saying, “Hey, I don't want to go to the emergency clinic.” And she's really hanging on. Seeing negative reviews is starting to bother her, even though she's really trying not to be bothered by this negative feedback from the clients who are frustrated that they can't get in. It's taken a toll and she does not want to give up. She wants to do the thing that she came to do and serve the purpose and take care of the pets. And at the same time, this has taken a toll on her. And she's like, “I don't know what else to do to keep the wheels on.”
And so, Stephanie and I talked last week and we talked a lot about… I talked about walking in the rain and I talked about the death spiral, which are different ways that we can get into this predicament. I talked about how common this is in Vet Medicine right now, how nobody can hire. It's very, very difficult to hire. There's a labor shortage. And so, a lot of us are having problem. We have unfilled job positions, things like that. A lot of us are working this way.
We talked a lot about sunk cost fallacy and how we get used to seeing a certain caseload and then our capacity to do that caseload falls off and we are unwilling to make adjustments with our new capacity. Things like that. We talked about responsibility that we have as far as pet owners deciding whether or not to take their pets to the emergency clinic and spoiler alert, it's not our responsibility. We have to be honest with them. We have to be honest about what we can do and it's their pet and we can't make them do anything. We talked about how it feels to have pet owners go to other practices and how maybe it should feel a lot less like a big deal.
Stephanie Goss:
It was a really great episode and if you missed it for some bizarre reason because…
Dr. Andy Roark:
So good.
Stephanie Goss:
… who wouldn't listen to us every week? If you missed it, you should go back and listen to the last episode because it was great. And we are going to pick up where we left off, which was we talked about head space. We talked about all of the things that Andy just recapped and we are about to dive into, “What do we actually do about this?” Because this is not a single-person problem. This is an industry-wide challenge to the point that you just brought up, Andy.
There is a labor shortage. Everybody is struggling with this. Everybody is struggling with feeling like they're a bit overwhelmed for a variety of different reasons. And there is this rebel fighting spirit of like, “I am not going to go down without a fight, so how do I actually fix this?”
Dr. Andy Roark:
Yeah, so the first step in this, for me, is to step away. The first thing is strategy. We need to disconnect ourself from working in the business and step back and work on the business because this is not as it's put forward, this is not a problem that's going to change. We're talking about we're a couple of technicians down, we're a couple of doctors down and it is hard to hire. There is no scenario where six people are going walk in…
Stephanie Goss:
Magically, yep.
Dr. Andy Roark:
… and take jobs next week and be ready to go. It is not going to happen. This is your new reality. And so, acceptance is the first part. And then strategy. All right? Guys, let's be honest with ourselves about who we are, what our capacity is, what our purpose is and what we're able to do. And separate ourselves from the pet owners in the exam room looking us in the eye asking for our help. That's working in the business. We're working on the business.
And so, it's about stepping back and saying, “All right. What can we do?” And so, my advice to you is to step back and say, “How many doctors do we have and how well are we able to support them with technicians? If we were opening up a brand new clinic, but again, setting aside our history, if we were opening up a brand new clinic, how many exam rooms would we use? And how many appointments would we see in our new clinic to service these doctors and keep them busy, but not burn them out?” And that is a painful exercise.
And I'm not saying you have to do exactly this, but I challenge you to unemotionally sit back and figure this out. And then, when we have these numbers and we say, “This is how I would do it and this is how we would staff,” I would say, “Great. Are our prices in line to do those things and to keep the doors open and to retain the staff and to make payroll, and things like that?” Because that is another thing where our pricing model was often built on us having a much bigger team and a much higher capacity and that changes. And I go, “Yep, that is an unfortunate thing.”
I hear from a lot of practice owners out there who are chewing their teeth and saying, “We can't raise prices.” And I say to them, “I'm sorry.” You, guys, if you've listened to my other podcast, Cone of Shame, you know that accessibility of care is a big deal for me and I want people to be able to get in and I do not want that to be a luxury item. And I promise you that I fight with this and I wrestle with this. At the same time, support staff salaries are going up. Inflation is a real thing.
Prices are getting more expensive. I mean I don't know about you, guys. Let's take gas out of this. Man, my grocery bill has gone steadily up and I buy the same thing. I'm a creature of habit. I buy the same thing. I swear I pay twice as much for it as I did a couple of years ago. It is valiant for us to want to fight these prices. At some point, it does no good for you to undervalue yourself and your staff and your staff leaves and goes to work somewhere else because they're able to pay a better rate. This is part of acceptance is let's be honest about the amount of work that we can do and then let's set prices to support our team in what we're doing.
And the good news is when people complain and they might, when they complain for us to say, “Hey, there's inflationary pressure. We are taking care of our staff. These are changes unfortunately that we need to make to stay in business.” To me, that is a very, very defensible position. I'm not saying that people will go, “Okay, that sounds great.” But I think at some level, it should not be unexpected for people and guys, it really doesn't matter because it is what's required for you to do your job.
Stephanie Goss:
And here's one of the things, this is, I see a lot of my peers and colleagues struggle with maths and let's be real. Maths are really hard, maybe second only to time zones being hard in the universe. But it is really a simple math equation. And walk with me here for a second, everybody, because if you take a step back and you look at your people and you say, “Okay, if we have one doctor now and we had four and we have two technicians and we had four, what can we do now?” I think that's a wonderful exercise and you do.
I love that you have to consider your pricing, Andy because that is the next piece. You have to think about, “Okay, if I'm now changing this patient load, what is my output going to be? And is that going to be enough to cover our butts and keep the lights on?” Okay? And then most of us look at it and say, “Okay, well, the only choice I have here is to drive up prices.” That's the first lever that a lot of us reach for. It's like, “Well, if I have less people, I'm just going to drive up the prices.”
And that's I think where the panic you're talking about, Andy, comes from our practice owners who are like, “But I can't raise the price from $20 to $40 for a thing because that's double. And owners will flip out and they'll never come back.” Okay. The thing that I think a lot of us have to keep in mind is that math is an equation. There is an equal sign in the middle and there is room on both sides to help balance this out. And so, too many of us look at it and say, “Well this is my only option.” But I will tell you if you increase a little bit on one side and you increase a little bit on the other side, you can still get to the equal in the middle, you guys.
And this is where so many of us look at it and panic and think, “This is the only button that I can push. I can only push more cases through the door or I could only push more money.” And really what this is about, the exercise for each one of us, because it is individual and every one of our clinics is going to be different. And if you do the work that you're talking about, Andy, if you step back and really work on the business instead of in it, you have to look at what is right for you and your team. And maybe the answer is your pricing model wasn't set up great and you should increase prices maybe even by more than double. That may be the answer in your clinic.
And also, there are plenty of clinics where the answer may be that, “Could you figure out a sustainable way to do a little bit more volume? Not a ton, not twice the caseload with half the people, but could we do a little bit more volume and keep our prices where they're at?” Maybe, right? But the answer is that there is room on both sides of this equation to balance things out. And I think that's a step that a lot of us, myself included, have missed because we stand there and panic and think the only option we have is to jack up our prices.
Dr. Andy Roark:
Yep. Yeah, I completely agree with that. Okay. I want to get into that in a second. Let me start here with, I want to talk for a second about capacity. And so, I talked about this in our last episode, but it's important enough I need to bring it back here and put it at the top. Okay. You, as an individual and your practice, but we're just talking about you as an individual. You, as an individual, you have a capacity.
There is a certain amount of work that you can do at a day in a healthy way. There's stress and there's distress and a healthy amount of stress is good. That means we're pushing ourselves, we're working hard. At some point, there is a capacity above which you are not stressed, you are distressed. Meaning, this sucks. You feel crappy at the end of the day.
Stephanie Goss:
And you go home crying.
Dr. Andy Roark:
And you don't look forward to coming back tomorrow. That's it. That's the line. You switch from, “Boy, I worked hard today. I'm kind of proud of myself,” to “That was sucky. And I'm going to be right back in it tomorrow and I feel crappy about it.” And if you are having those thoughts as you leave practice, you, my friend have switched. You've pushed past stress into distress. That's capacity.
Now, you can push past healthy capacity into distress and you can do that for a day or you may be able to do that for a week. You may be able to do it for a month or even three months or six months or maybe a year, the bill comes due and you need to know that. The other thing is, it is, I have never seen a scenario where the doctor is pushed to distress, but the team is happy.
Stephanie Goss:
Right. I was going to say.
Dr. Andy Roark:
If you're feeling that, you better believe your team is feeling something very similar and you might be motivated and dedicated and you might own this practice or you might not. You might just be like, “But I don't break. I don't give up.” Other people, that's your own weirdness that you came up with that, yeah, you can take that on for yourself if you want, but you are also dragging other people into that. And they may not feel the same way because they're healthy. They have a healthy perspective. Maybe that's why, but-
Stephanie Goss:
They have boundaries. The other thing that I think is really important here to call out and I'm going to call this out because I have been this leader. No matter how much of a poker face you think you have, no matter how well you think you hide your distress, my team doesn't know how worried I am. They know.
Dr. Andy Roark:
Yes, they do.
Stephanie Goss:
They know. And to your point, Andy, you might be able to hide it for a day, but if you are a leader and you are operating in the place of distress for any sustained amount of time, no matter how good you think your poker face is, your team knows.
Dr. Andy Roark:
Well, everybody has a bad day. But if you have a bad day after a bad day, after a bad day, after a bad day, that radiates out, right?
Stephanie Goss:
Yes.
Dr. Andy Roark:
Culture comes from the top and stressed out, that's a type of culture. We have all seen a stressed out culture. It comes from the top. And so, if you're the medical director, if you're the practice manager, if you're the practice owner and you are just stressed every day then that's radiating out. And so, I say this because it's important. The goal for you in practice should be to do good in the world, the most good in the world.
And if you work past your capacity and your staff quits and now, you're shorthanded, you are doing less good in the world over the long term than you would have been had you rationed it down to a reasonable capacity and kept your staff intact. And if you want to do good in the world and you see all the pets and you burn out in four years and you leave the profession, you're going to see way less pets and do way less good than you would have had you done less and stayed in the profession for 20 years. And not by a little bit like a couple extra pets like…
Stephanie Goss:
A lot.
Dr. Andy Roark:
… by orders of magnitude. And so, if you say, “I'm here for the pets. I'm here for the community,” what I would say to you is, “Are you here for the community in the year 2022, 2023 and 2024? Is that what you're saying? Or are you saying that I'm here in the community for the next 15 or 20 years until I retire?” And you need to make that choice. You need to make it now because my friend are running this race like a sprint and you're in a marathon.
And so, anyway, but we have to put that forward. And if you don't buy into that, if you say, “Nope. I don't believe in this idea of a capacity. I can just work hard forever and not break,” I can't help you.
Stephanie Goss:
Good luck.
Dr. Andy Roark:
I'm sorry I can't help you. I would say you are kidding yourself and it's time to get realistic about you being a human being and your own mortality. But once you do that then we can settle into the real work of saying, “How do I maximize my benefit to society, to pets, to people, to my community?” And also, “How do I balance my own enjoyment of this one trip that I get on this spinning globe?” Because you only get to go through the ride one time and this is your life right now and you better enjoy it because it's all you get.
Stephanie Goss:
Okay, so if we accept the fact that we have capacity and we need to figure out what that capacity is, then where do we go?
Dr. Andy Roark:
All right. Great. So, we've got a couple of things that, and they're all interconnected, which is why it's a little bit of a tricky fish. All right, so access Step No. 1 is efficiency. Well, first of all, you might look at your capacity and how you're priced and you go, “Yeah, that's it. We're going to make some adjustments to our current schedule.” Guys, let's actually start with that.
So, I'm going to start with scheduling. Scheduling is one of the first easiest things to help people out and I'm amazed at how many people do not feel good about their schedule or how they do scheduling. If you need a little bit of extra help in scheduling, we do have a course inside. It's the Knowledge Library in Uncharted, it's run by Dr. Saye Clement. It's actually really, really good. It's a way that Uncharted teaches scheduling. She does a fantastic job with it, laying it out. But if you really want help with scheduling, there's an Uncharted course that we have in the knowledge library and we should probably run that again before long.
Anyway, big things for me. You need to have a plan, right?
Stephanie Goss:
Yeah.
Dr. Andy Roark:
You need to have a plan and if every day you're just getting overwhelmed, you have a bad plan. If you are not doing schedule blocks, meaning, when we look at our schedule, we need to be intentional about what we're doing. And as we always say on this podcast, if you're surprised by something again and again and again, at some point, it's not a surprise, it's your business model. And it's amazing to me how many practices still fill their appointment slots up with wellness appointments and then act surprised sick pets have the audacity to show up on of them.
Stephanie Goss:
Thank you for saying that. Oh, my goodness. Thank you, thank you, thank you, thank you, thank you.
Dr. Andy Roark:
So, if your doctors are continuously running behind and they're stressed out, and I'll push you on this and say, if your doctors are, as a group, all staying late at night to write up charts, I would say you are pushing them past capacity, right?
Stephanie Goss:
Yes.
Dr. Andy Roark:
They need to have time to write up their records as they go along. And there's a fall off the medical quality when people put off records to the end of the day, saying, “Oh, we are keeping up because we're not doing this essential part of practicing medicine.” That's not keeping up, friends and it's bullshit. Pardon me. It's bullshit to run the doctors as hard as you can and say, “You get out of here at 6:00,” and then they're here until 8:30 because they're doing this thing that is essential for their job. That's not okay.
Stephanie Goss:
I think we have to stop for a second because there are so many practices, my own practice included, where the model was, “Let's keep the clients on time. Let's get the clients out on time. Let's get the team out on time.” And then the expectation is that the doctors are calling back clients and writing on medical records for anywhere from one to four hours after the rest of the team has gone home. And I agree with you, Andy, that is total. And it is something culturally that we absolutely have in our control to change.
Dr. Andy Roark:
Yeah. Now, I did say as a group, and I have to throw this caveat in because I 100% have worked in a practice where I am out on time and there is one doctor that's staying there until 9:00. And I would say that is a personal problem and I think a lot of doctors really struggle with that. If you are insisting on writing up three pages of medical records for every appointment that you see and not being efficient in your records and not looking at what other doctors are doing and not figuring out how to get out on time. That my friend, that is a personal problem that I think is often tied to a perfectionist personality and things like that.
And that is something that some people have to really struggle with and work with. And so, that is why I said, we need to look at the doctors as a group. But if the culture is everybody stays and writes up their records at the end of the day, I think that's a problem. And so what do we do? We need to be honest about keeping up and the first thing is to put some catch-up blocks. If you have a walk-in practice or a walk-in practice that takes appointments and also walk-ins, boy, if your doctors are always 30 minutes behind, by 3:00 PM you need to have a block. You need to stop taking appointments at 3:00 PM and have a block and say, “This is catch-up time.” And so, that's one of the first easiest things is be honest about how your doctors are running. And at some point, you can't take an appointment because they need to catch up.
The other thing is, again, if you have walk-ins, same day appointments. I'm a big believer in if people are going to walk in and your doctors are getting swamped, you need to have some appointments that are blocked off that cannot be filled until the day of the appointment.
Stephanie Goss:
And I have to say this because I see it every single day in the communities that I am a part of, including in Uncharted, where somebody asks the question still, we are how many years into this pandemic and the changes that we've had with our schedule. And somebody says, “But we have three sick pet blocks on the schedule for the day. And everyday, it's just not enough and it's not been enough for three years.” That is the problem.
You have to step back and look at that. Like you said, Andy, if you're asking the same question over and over again. Good, if you're surprised, it's your business model. And the reality is no practice, not even a single doctor practice most of the time, I would argue, and this is one that I would… well, this is a hill I will die on, can have three sick pet appointments in a day and not fill them. We are in a place where we all have clients coming out our ears and what used to work for us having two or three sick pet appointments per doctor doesn't work anymore. When's the last time you only saw three sick pets in a day?
Dr. Andy Roark:
Yeah.
Stephanie Goss:
It's been years. Sometimes, we go through waves where there's not a lot of sick patients, but be honest with yourselves and your team. Sit back and ask yourself the question, “When's the last time we only saw three sick pets in a day?” And really, I think, I'm so glad that you brought it up because I think we need a radical overhaul of how a lot of us are approaching scheduling because we are doing it to ourselves.
We are letting ourselves be surprised over and over and over again and it has become our business model. And I see it and it drives me crazy because it goes back to what you said about in the head space piece, about we don't have to keep doing what we've always done and this is the prime example for me when it comes to scheduling. Well, but we are leaving two or three spaces. Ask your team that question. Ask your CSRs, “When's the last time we only had three call-ins in the morning for sick pets?”
Dr. Andy Roark:
Yeah, yeah. I completely agree. At some point, some of this probably starts with auditing. It's, “Take a moment and we're going to work on the business.” Look. Look objectively at what's actually coming in. Are you getting a ton of sick pets? Are you getting single sick pets that are really sick? Are you getting a ton of sick pets that are mildly sick? Are you getting sick pets that really could be, they could wait another day or two but they just they don't want to? Are you getting really sick pets that are getting turned away because mildly sick pets got those appointment slots first thing in the morning? All of those things can be adjusted.
I've come a long way on charging emergency fee as well and I still waffle back and forth. And what I'm going to say is it depends. It really depends on what you're looking at and how you're looking at it. There are downsides to charging an emergency fee to get in. Meaning, that some pet owners don't like it. If you are looking at a place where you have a certain number of sick pet slots a day and those are getting grabbed by people that could conceivably wait a little bit longer, they just don't want to, then it may be time to put an emergency fee on there that says, “Well, if you're going to come in as an emergency, you're going to pay more.”
And the idea of that, honestly, is not about making money, it's about making it a bit of a barrier so that people are incentivized to wait an extra day or two if appropriate, obviously. And we're going to have to teach our techs or our front desk on that.
Stephanie Goss:
And that's where you think about the human emergency room. That you go to the emergency room when it's truly emergency and there are lots of people who are like it's not “I don't want to wait.” Sometimes, it's “I don't feel like I could wait and I'm not sure.” And I think that that is medically acceptable. And there's also lots of people, and I hate to say this, but having kids, I've been that person where I'm like, “I can't wait another two weeks to get in. I will just pay the extra money to go.”
And I know full well I'm going to sit in the ER and so, I time it, so that I have the time to sit there with my kid. But when they've got an ear infection and I need to start meds now, not three days from now or four days from now, that's the price I'm willing to pay. And I think we have that model in human medicine. And let's be honest, it does not come without problems. It is part of why the emergency rooms are overwhelmed, both in human medicine and in animal medicine. And I recognize that and I'm not advocating for it because I don't think that is the only solution.
But I think your point, Andy, about there are always going to be clients, who are willing to pay no matter or do whatever, no matter the barriers you put up. And so, I think we have to acknowledge that and recognize that it's happening and also have a plan to help discourage the majority, so that we can help more people.
Dr. Andy Roark:
Yeah. And that's where the line in this. It's not about trying to punish people who have emergencies. It's really not. And so, I'm not like, “Charge more and more.” It needs to be enough ideally that it incentivizes people who we think that their pets can wait. It incentivizes them to just wait a couple of days and leave spots open for people who really need it. At some point, it's not about punishing people who have true emergencies.
The other thing is if you're at capacity and you say, “We cannot turn away sick pets. We just cannot do it and we're at capacity and these are coming in on top.” I would say, I think an emergency fee is absolutely warranted once you hit capacity. So, you might even have same day slots that can be filled, but once those same day slots are filled, if you still want to take emergency, you can. But that my friend is a bonafide emergency and is getting emergency fee. And I would figure out how to take that and give it back to the doctors or back to the staff because they're getting this extra stuff dumped on them. And while I'm trying my best to reduce that load, if I can't reduce it, I'm at least going to try to do something that is nice for those people.
And so, anyway, I'll give you a quick example. If you have doctors that are paid on production or pro-sal and you add an emergency fee, they're at least getting some extra compensation for taking that emergency over just another appointment that's being dropped on their plate. And that's just something to think about. In doing scheduling, we need to have a system for communicating from the back up to the front.
And so, if you're going to take walk-ins, one of the big things I see is the back is completely slammed. It is pandemonium and people are crying and the people up front are blissfully unaware. They know it's busy, but they don't see the chaos going on in the back. And so, they're taking walk-ins and sitting them down and things like that and the back gets super mad at the front. And the front is like, “What? We're doing our job. We have no idea.”
I really am a big fan, if this continues to be a problem where the back is getting angry at the front because the front keeps letting people come in, we need a communication system. And that can be, I've seen some light systems where people in the back can flip switches or hit a button. And there's a little green light that's front which means, “Hey, we're good if people walk in.” And there's yellow, which means, “Tell them that there's going to be a 30-plus minute wait.” And then there's red, which means, “We are not able to see anyone for the next three to five hours.”
And then at least the front desk knows if someone walks in, you can say, “We are not taking any more walk-ins. It's going to be at least a five-hour wait. We recommend you going somewhere else. We're not going to be able to see you today.” A lot of this stuff is clear communications and it's amazing how we suck it up and we don't tell pet owners. And again, if the pet owner is willing to pay the emergency fee and they're willing to wait five hours and it's not going to put us working past close, okay.
But it should at least be like a restaurant where you go into a restaurant and we've all walked into restaurants and the place is packed and they're like, “Oh, we might have open tables at 9:00 PM.” That's it. “We might be able to seat you at 9:00, but I can't even promise that.” And I go, “Well, I'm going somewhere else.” And then I leave, but at least I'm given that information. So, anyway, that's sort of back to front communication. Clear expectations, I think are the other part that I was just saying is we need to let clients know we are completely filled up. And if you want to be here, you're going to pay an emergency fee and you're probably going to wait four to five hours.
Stephanie Goss:
I love that and I think the other piece about communication, I was thinking while you were saying that, I think the other piece about communication is a lot of us are afraid. I have felt afraid to communicate outwardly to clients what is happening for fear that of I guess, of judgment of that they're going to think that things are falling apart. That we don't have our ish together. I've been there when you have gone from four doctors to one and it's like, “Do I tell them?” And the answer is yes.
Dr. Andy Roark:
Yes. The answer is yes.
Stephanie Goss:
If you are not communicating to them and you are not setting expectations, you are failing them. And a lot of times we make those decisions because we're afraid. Like, “Oh, but we're working on hiring other doctors. We're working on getting relief, so I'm just going to hold off on telling them.” It's all done with the best of intentions and I say that because I have been there. And at the same time, we are doing them a disservice when we are not communicating to them the expectation for reality.
And I have seen more and more clinics start to be open and honest about that and I think that there's ways that we can do that that are more successful than others. And I think a lot of us communicate from that place of panic and it can outwardly look a lot more chaotic or discombobulated, which is not what we want. So, I think it has to be strategic and smart. But look, if your reality is you were a four-doctor practice and you're now a one-doctor practice, you have to communicate that to your clients.
You are going to change your business model. You cannot go from seeing 50 patients in a day to seeing a one-doctor caseload and not have clients hacked off when you tell them, “It's three months from now before I can schedule you.” You have to take control of that situation and do some communicating. And so, I love your ideas, Andy, about communicating in the thick of it in the day between front versus back and also, with the clients as well.
And I've seen more of my peers start to have and share outwardly their local clinics and ERs have spreadsheets that they're using together to communicate, “Are they taking patients? Are they closed to patients? What's their wait time?” I've seen more of my GP colleagues share that kind of information outwardly on their Facebook pages, websites, whatever, for their clients to have access to it. Which helps them cut down on the volume because if clients can get that information themselves and see that there's a wait, it cuts down on the calls that the GP and the ER are both fielding, which is brilliant.
But also, being able to communicate that if within your own practice as well, but also the long-term piece of it. If this is not a short, if everybody is out with COVID, that's one thing. If you're closing temporarily because you've got a stomach bug going through a clinic, whatever, but when your reality is going to change for an extended period of time, it is your job to communicate that to your clients as well or we are failing them.
Dr. Andy Roark:
Yeah. You can be vulnerable, honest and a professional at the same time and you should. This falls right into our category of pick your poison. Do you want to not tell people what's going on or the realities of the situation because they might think less of you and deliver a crappy customer service performance because their expectation is that there's nothing going on and you should be functioning at full capacity? Or do you want to tell them this is our reality at the moment and thus, what you should expect in your visit and have them be disappointed that they're not going to get in, but also not be surprised?
Remember people don't get mad about what you give to them. They get mad about the difference in what they got and what they expected to get. And they're expecting to get what they've got in the past and they're going to be mad even though you do your absolute best. And I think that that is really important point.
I've got an article that just came out in today's Veterinary Business this month and I looked at it yesterday, I had completely forgotten what I have written. But I wrote about being in Charlottesville, Virginia with my wife and we were on vacation. We were just driving and hiking and stuff. And I went to this bougie little breakfast place with Allison and it was $8 for a cup of coffee.
Stephanie Goss:
Oh, my God.
Dr. Andy Roark:
$8 for a cup of coffee and it was very good coffee, still eight bucks for a cup of coffee. And then I ordered a breakfast thing and they brought a biscuit, but they didn't have any jelly for it or anything and it was not where I feel comfortable. That's not where I eat and especially, it made my wife extremely uncomfortable because I asked if I'd had to pay for refills of coffee. And I asked her if the water was free because I was looking into the menu and I'm like, “Is water free? Do I have to pay for more coffee?” And because I was like, “This is ridiculous.” So, anyway, so there I was-
Stephanie Goss:
I could just imagine Alli's face. Okay. Keep going.
Dr. Andy Roark:
I was like, “Is water free?” And she was like, “Ah.”
Stephanie Goss:
Again, “I can't with you.”
Dr. Andy Roark:
I see her jumping back 25 years and going, “Why did I agree to marry this man? This is the man that I married.” So, anyway, so there we are. And I'm drinking this $8 cup of coffee and it's great, but then it's gone. And so, I've got an empty cup of coffee and I've got this biscuit that does not have any jelly on it and this biscuit needs some jelly.
And there's one server and she is busting her hump. She has a smile on her face. She's seating people. She's running around. She's taking orders. Honestly, she's amazing. But there's one thing she's not doing and that's getting me more coffee or coming over, so I can ask for jelly for my biscuit. And minutes and minutes and minutes and minutes go by, and I'm sitting there. I'm turned around, trying to get her attention and she is working as hard as she can.
And so, at one point I get up and I go to the restroom and she's at the bar making this coffee drink for someone. And I said, “Boy, you're really working hard.” And she was like, “Yeah.” And I said, “Is it always this busy?” And she said, “Oh, yeah.” And I said, “Do you always work alone?” And she kind of pursed her lips and she made eye contact and she said, “No.” And I'm sure that someone…
Stephanie Goss:
Called out. Yeah.
Dr. Andy Roark:
… or called out or they have a new hire, anyway. Anyway, I tell this whole story because that person was busting her butt. She did not stop moving and the smile on her face never wavered and I didn't get a refill on my $8 coffee and I never got a jelly on my biscuit.
Stephanie Goss:
Right. You're still frustrated by this. Yeah.
Dr. Andy Roark:
And I'm still frustrated. And guys that's life sometimes, is that everyone can do the absolute best they can and it's still a frustrating experience. And so, I bring that up now because that is how a lot of us live. And so, tell them that you're working by yourself. Tell them how, we know what to expect and know it's not pleasant and know you'd rather not do it. But a lot of that, and a lot of it us start doing some weird Weekend at Bernie's thing where we're like, “No, he's fine.” We're acting like our corpse friend is alive. It's ridiculous. Everyone can tell. It's not exactly.
Stephanie Goss:
We've just dated ourselves because there's a ton of people listening to the podcast who have no idea what that movie is.
Dr. Andy Roark:
Yeah. Oh, yeah. If you want to see something weird and ridiculous and you don't know what Weekend at Bernie's is, go and YouTube, the trailer for Weekend at Bernie's and say, “Andy Roark says that's what we're doing.” A lot of us are pretending like we're fully staffed and we are not.
And so, anyway, pick your poison. Be honest. You can be vulnerable. You can be honest and you can be professional. You can set clear expectations and set them up front. And I tell you a lot of the stress goes away. Practice. Talk to your staff about how to communicate that and then let pet owners know what their expectation should be. And if they don't like what you're telling them and they decide to go somewhere else that is okay.
Stephanie Goss:
Be okay.
Dr. Andy Roark:
And it better be okay because you're burning out.
Stephanie Goss:
Yep, yep. Yeah.
Dr. Andy Roark:
And the last part is when we talk about training our staff, train them how to tell people that we're not taking any more walk-ins today. And set a time. If you close at 6:00, tell people you don't take walk-ins after 5:30 and mean it. Don't make it some, “We don't take walk-ins after 5:30 unless the doctor says that it's okay.” And they say, “Well go ask the doctor if it's okay.” And remind them of all the times I've come here and tell them how far I drove to be here and that I'm having terrible hardships in my life. And then they tell the doctor and the doctor folds like origami every time.
Stephanie Goss:
Every time. Every time. Bless their hearts. And I love my doctors for doing it.
Dr. Andy Roark:
Sure.
Stephanie Goss:
And at the same time, this is where it's really important. When you're in this overwhelmed mode, this is where as a leader, a lot of the head space pieces that we talked about in last week's episode, it has to start with you. And this is a piece, the communication piece, the training piece, the decision-making piece about what are we doing has to involve the team. And there's a lot of practice owners that are like, “But I have to decide what's best for the business.” And that is true.
And your people are going to leave if you don't take care of them. That is also true and so, this is where asking them for their input. It doesn't mean that you're going to go the way that they want you to, but they have to feel heard. And this is where you have to step back and say, “Okay. My doctors want to take care of all the patients.” And a lot of them are paid on ProSal. And so, a lot of them are motivated by taking care of all of the patients, so that they get paid. Those two things are true.
And it doesn't mean that the team having lives outside of the practice is not as important as paying your doctors. Those things have to exist together and this is where you have to have the conversation. And the team has to be able to agree on some of what your standards or your timelines or like you said, Andy, like if your cutoff is going to be 5:30 or 6:00, there has to be conversation. Because no one is set up for success if your hours are 8:00 to 6:00 and you see patients literally from the minute you're open until the minute 6:00 rolls around on the clock, your hours are 8:00 to 6:00, but your team is going to be there at least until 7:00.
And if you're staffing them to only be there at 6:00, you're setting yourself up for failure every time. And so many of us do it because we think we're going to say no at 5:00 and we think we're going to say no at 5:30. And we might have all of the best intentions in the world, but if the whole team isn't on board, if there hasn't been a discussion about it, if you don't have an actual plan like you were creating the business model that your team is there until 7:00.
Dr. Andy Roark:
Yep. And if you want to let people walk in and you're going to take these cases and you know that you're not going to turn people away, that's not wrong.
Stephanie Goss:
No.
Dr. Andy Roark:
It's not.
Stephanie Goss:
Nope.
Dr. Andy Roark:
But own it, and staff for it and budget for it. And have a fair system about determining, who's going to stay late so that the nice doctor and the nice tech don't get screwed over again and again and again. And the people and I say nice, but the people who go, “Nope, I'm not doing this,” they benefit every time.
And so, I just see that all the time of like I say, I'm like, “Hey, who stays late?” And they're like, “Oh, Carol. She's single.” I'm like, “That sucks. That's not fair. That's not remotely fair.”
Stephanie Goss:
What happens when Carol has something to do?
Dr. Andy Roark:
Yeah. You can do an on-call system, but for God's sake, schedule it, communicate it, talk to the team about it. The Uncharted approach that we teach a lot, there's nothing wrong with sitting down and talking to the team and saying, “Guys. This is the reality and people come in and they want our help. At the end of the day, what do we want to do? Do we want to say no and make it no? Do we want to take it on a case-by-case basis? Do we want to plan on this and make a system?”
And you don't have to commit to anything the team says, but man, you can go a long way in making them feel heard. You got to really listen to them. But if every one of them is like, “No, no, no,” then that's your policy. And you go, “Listen, we talked to them. They said, ‘No, no, no, no, no.'” They told you. And if you say to pet owners, “I'm sorry. We do not have the staff available to do this. We cannot see you. These people, their shift is over and they're going home.” And I wouldn't say exactly that, but you get my point.
Stephanie Goss:
Right.
Dr. Andy Roark:
Then that's what it is.
Stephanie Goss:
Yes. And I think goes back to your point about when you go into a restaurant and they tell you it's going to be two hours for a table, they are setting clear expectations for you. You can wait two hours for a table or you can leave. Those are your choices. And I think in Veterinary Medicine like so many of us reach for the, “We want them to understand.” We want them to not judge us. We want them to not look at us negatively and so we overshare.
And so, this is why a lot of us don't communicate when we've gone from a four-doctor practice to a one-doctor practice because we do it and we either overshare or we're afraid we're going to tell them too much and so, we just don't say anything at all. And the reality is this requires finesse and it requires education and your team has to know what to say and how to say it.
But you can absolutely educate them to channel that front desk host at a restaurant and be able to communicate to our clients, “This is what I can do for you. I can seat you in two hours. I can see Fluffy in two hours,” or “You're welcome to call and see if any of the other practices in town can see you sooner,” like that. There's nothing wrong with communicating those boundaries. And I think systemically in Veterinary Medicine, we want to help take care of everybody and so, we've been afraid of that and we have got to get over that.
Dr. Andy Roark:
Yep. That's like the hostess at Olive Garden is not going to run after you and be like, “Please, don't leave. Please, please, wait.” No. We need to move a bit more than that.
Stephanie Goss:
You're 100% right.
Dr. Andy Roark:
Yeah. We to move a bit more in that direction of putting our oxygen mask on ourselves. I want to move past scheduling here.
Stephanie Goss:
Okay.
Dr. Andy Roark:
I want to talk about sacred cows.
Stephanie Goss:
Okay.
Dr. Andy Roark:
Sacred cows are the core beliefs that you have that you believe cannot be touched in your practice and so, part of this is examining your sacred cows. What are the restraints that you have put on yourself and your practice because it just seems like this can't be changed and it's holding you back. And I'll give you an example of this. Well, first of all, the first example of sacred cows is referring to other practices and saying, “We can't get you in, but here's another practice that could see you,” or “Yeah, there's three other practices nearby who might have availability.” And you go, “That's heresy.” And I go. That's your sacred cow. I just poked your sacred cow.”
The other one is we have to be open every day. We have to be open on Saturdays. Surely, we have to be open on Saturdays. It's our busiest day of the week. And I'm like, “It's your busiest day of the week and you're burning out and drowning.” It is not heresy to not be open on Saturday if you can't staff for six days a week. I mean that's it. We have practices in Uncharted that are closed on Wednesdays and people are like, “That's not allowed.” I promise you it is. No one is going to show up and be like, “You have to be open on Wednesdays.” We have practices that are open Monday, Tuesday, Thursday, Friday and Saturday half day and that's their week. And they're like, “Yeah, everybody is off on Wednesday. Everyone gets Wednesday off.” That's great.
Or they'll have one front desk person there or they'll have one front desk person who works from home and like yeah, you're on the phones, but you can be in your pajamas and you can be home and that's what it is. You could do a million things. What are your sacred cows? If you are buried, you don't have to be open. We have lots and lots of practices, I see it especially on smaller practices or one vet practices, they're not open on Saturday.
Stephanie Goss:
Yeah. And I think that from a leadership perspective, I think, I'm going to speak for myself here, a lot when I was a younger manager, I was afraid to poke the sacred cows. But I was also afraid to change those kind of things because I didn't know how to smartly make the decision. I looked at it and I said, “Well, I can't staff Saturdays and everybody's burning out.” And so in my head I think, “Well, it seems like closing Saturdays is a good idea.”
And I think a lot of us struggle with like, “But is this just a gut feeling? Do I go with my gut here?” And a lot of us struggle with knowing, I did, with how do I crunch those numbers? How do I look at those things? How do I smartly measure? And this is where numbers need to be your friends, because to your point, Andy, you should be able to look at that. Is Saturday really your busiest day of the week? You should be able to audit that in your software and tell down to the minute what your busiest day is. And if you can't do that, you can grow in a lot of ways by learning how to do those things.
And don't like don't be afraid of what you don't know. Don't be ashamed that you don't know how to do any of that because there are plenty of us, myself included, who have sat there and gone, “I have no idea. How do I calculate that?” And that's where I love our community, the Uncharted community because…
Dr. Andy Roark:
I was just going to say.
Stephanie Goss:
… how many times have I gone, “Okay, I need to do this math in the clinic. How do I actually do this?” And phone a friend and just ask. There's no shame in saying, “I don't know how to do this,” because most of us didn't go to business school. That's why I went to vet school. There are some who also have MBAs, but lots of us didn't go to business school.
And so being able to say, “How do I make these decisions?” Because you shouldn't make it in a vacuum. You should listen to your team. You should weigh in and you should be able to poke those sacred cows. And also then, a lot of us sit in that place of fear and paralysis in terms of decision-making because we don't know how to make the decision.
Dr. Andy Roark:
Yeah. I feel like we're plugging Uncharted a lot and it's just, it's because we're talking about big action steps that we don't have time to unpack everything. Stephanie Goss teaches a course in Uncharted and it's in the Knowledge Library and we run it fairly regularly on key performance indicators and financial dashboards and things like that. So, if you're like, “I have no idea how to even figure these things out,” we got you buddy. Check out the Uncharted community.
But anyway, you don't have to be open on Saturdays. And I'm not saying, I don't want people to go, “Andy Roark says we shouldn't be open on Saturdays.” I didn't say that. I'm saying it's not a sacred idea. Here's the other thing. I'll really blow your mind. What if you're open one Saturday a month? What if you're open every other Saturday and say, yes, there's communication challenges there, but that's not out. It's not illegal.
The other thing is just because you're not open for Saturdays right now, it doesn't mean that you're not going to open back up for Saturdays in three months. What if you said, “Hey, we need to hire two doctors and when we do hire two doctors, we're going to open back up on Saturdays.” And doctors coming in will know that that's the plan and that's where we're going.
It doesn't have to be a scary thing. It can be, “Right now, we're not able to keep Saturdays open.” And that's where we are. And we hope to open back up on Saturdays, so when people say, “I wish you were open on Saturdays,” you could say, “Me, too, buddy. We are working toward towards it.”
Stephanie Goss:
We are working towards that.
Dr. Andy Roark:
Exactly.
Stephanie Goss:
Yeah. And it goes on both sides. You have to communicate that to your clients and you have to communicate that to the team. And I think that that's important. We have to set expectations, and that's where a lot of us struggle.
Dr. Andy Roark:
I agree. So, look at your sacred cows. There's a lot of people who just the idea being closed on Wednesday or every Wednesday afternoon, that seems terrifying and wrong to some people. And I go, “No, it's not wrong. We got a lot of practices that do it.” If that's what you need in order to serve your capacity, if you say, “We're closed on Wednesday and we are working at maximum capacity every day we're here,” I'd say, “You're doing it right.”
Are you priced appropriately, so the numbers make sense and your business is healthy? If the answer is yes, then go forth and carry the torch. That's awesome. And the last thing I'm going to talk about before we run out of time, and a lot of people think this is the first thing, it's not, it's the last thing. It's efficiency. And people are like, “Yes, tell me how to not change anything except get more work done, doing things exactly the way that I'm doing them now?” And I go, “That's not what this means.”
You might be able to increase efficiency. The problem, the honest to God tactical on the ground problem, is increasing efficiency often involves training. And if you're already overwhelmed and drowning, it can be extremely hard to do the training required to change your operation system while keeping your nose and mouth above water. And so, I'm not saying you can't do this.
Generally, like most things, a multimodal approach is going to be your saving grace. And so, you might close on Wednesdays and then use Wednesdays as training days to reevaluate your workflow, how you're moving people through the clinics. And guys, the biggest thing we talk about efficiency, the easiest go-to in most practices is, “Are you leveraging your support staff? Are your techs doing stuff that they could be doing or is everybody waiting?”
The quick thing I'm just going to say on efficiency and making it work is just like we started at the beginning and said, “You need to do some analytics. You need to look at your workflow.” You need to look at what's actually happening and gather some data. You need to do some data gathering on how pets are being seen in your practice and you need to look for bottlenecks. Where are the places where support staff are standing around waiting for a doctor? Where are the places where the doctor is standing around waiting for support staff? And we need to make adjustments.
And that honestly often runs into your sacred cows. People will say, “Well, our support staff get the histories.” And I'm like, “Is the doctor waiting in the treatment room for you to get this history.” I say, we need to look at that and have an audible that can be called where the doctor is free and we're going to have a modified-
Stephanie Goss:
They're just going to have to do it.
Dr. Andy Roark:
Yeah, we're going to have a modified doctor's ready to-go history that gets us into that room. And even say to people, “Guys, this is a way that we're going to run this while we're shorthanded and we're going to come back to it.” Are there things that the doctors are doing that the techs could do? And that's an easy one. It's like, “Hey, buddy. You got three technicians for every doctor, or you got one technician and an assistant for every doctor.
You need to get smart and look at how things are getting done and reallocate the workload there because a lot of times I can take some work off that doctor's plate and that is the rate limiting step. And so, anyway, and last of all, you look at efficiency, but know that you're probably going to have to poke some sacred cows. You're probably going to have to set some boundaries and change some scheduling stuff up. You're probably going to have to figure out how to do some training, communication training, maybe technical training to make this happen.
It is not simply, “Let's shift some things around. This is a bit of a process, but if you're committed to it, it's going to take some time. But week after week, walking in the rain, put one foot in front of the other and walk that training through your practice. Get people on board. Make small steps. Make small changes and keep making changes, you will be okay and you will come out the other side.
Stephanie Goss:
Yeah. I love it. Ooh, this is a good one.
Dr. Andy Roark:
Yeah. Boy, I'm really glad we decided to split this into two. Now, that we're in it, I'm like…
Stephanie Goss:
Could you imagine?
Dr. Andy Roark:
… I was rushed at the end. They are trying to get everything out and holy moly, yeah.
Stephanie Goss:
Oh, okay. Our first two-parter in the books. Have a fantastic week, everybody.
Dr. Andy Roark:
Yeah, everybody.
Stephanie Goss:
Take care.
Dr. Andy Roark:
You guys take care yourselves.
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.
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