This week on the podcast…
This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are talking through a conversation they recently had with a colleague who wants to proudly raise their hands and shout “Me, me, me” when someone asks who pays their team more than anyone else in their area. And this practice owner was also asking how to do that while still not pricing their working clients out of affording their services. This was a spicy one full of strong thoughts from both Andy and Stephanie so 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
Upcoming Events
TEXTING IT TO THE NEXT LEVEL with Maria Pirita
If you've ever been misunderstood through text messages – this workshop is for you! Using digital communications like email and text is without a doubt extremely efficient, but written messages can often be misinterpreted. There is also a perception that text communications feel less personal. This doesn't have to be the case!
In this workshop, Maria Pirita will be giving you techniques, tips and tricks that will take your texting to the next level! You will learn the benefits of text communication, a comprehensive list of do's and don'ts when texting, and formulate a protocol that can be adopted right away in your practice.
When: February 15, 2023, 8-10 PM ET/5 – 7 PM PT
April 20-22, 2023 – The Uncharted Veterinary Conference
Climb aboard with members of the Uncharted Community and our sea-worthy crew for a new adventure in veterinary medicine April 20-22, 2023 in Greenville, SC.
Get ready to explore new harbors together in overcoming digital communication pitfalls, developing resilience in an emotionally taxing field, and focusing on communication to build a positive team culture.
A UVC MEMBERSHIP IS YOUR KEY TO FINALLY GETTING THINGS DONE AND GROWING YOUR VETERINARY PRACTICE.
Episode Transcript
Stephanie Goss:
Hey, everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, Andy and I are continuing a conversation that got started with a colleague about how do we have the most highly compensated team in our area, and how do we do it simultaneously while still providing services that the working class families who come to us as clients can afford. This one was so fun. There is definitely some soapboxing from Andy and I, about a couple of topics, but I think we both really enjoyed getting into this in the meat and potatoes of it and talking with all of you about what we can do to leverage our teams and get the most out of the team as a whole, so that the techs in particular and the patient care team can help produce revenue for the practice and raise the pay ceiling for everybody. Let's get into this, shall we?
Meg:
And now, the Uncharted Podcast.
Andy Roark:
And we are back. It's me, Dr. Andy Roark, and Stephanie I have not remotely thought about what her nickname is Goss.
Stephanie Goss:
Talk about me about being unprepared.
Andy Roark:
Yeah, oh, and I was so relishing just going, are you ready yet? I'm going to hit record, are you ready yet? And watching you flail around that I completely forgot what my role was when I hit record. No, that was on me.
Stephanie Goss:
Karma.
Andy Roark:
Yes. That was 100%. It's 100% karma. It's absolutely on brand for right now, too. We're recording this the first week of the year, and the first week of the year is the Monday of the year.
Stephanie Goss:
Uh-huh.
Andy Roark:
You know what I mean? It's a week, maybe more of just consecutive Mondays because everyone's like, “Oh, crap. Let's be honest, we took most of the last month off.” All those things you were like, “That sounds like a 2023 problem.” They're all waiting-
Stephanie Goss:
Now, it's 2023.
Andy Roark:
… right here and it has been.
Stephanie Goss:
Oh, man it's so-
Andy Roark:
It's been absolutely bonkers.
Stephanie Goss:
It's so funny because you called me, and we were talking on not Monday. Yeah, on Monday, Tuesday, I don't know, beginning of the week, and you called me, and I had to take a breath because I was right in the middle of something and you're like, “Are you okay?” And I'm like, “It's a Monday.”
Andy Roark:
Yeah.
Stephanie Goss:
Because it is like my desk is covered in crap. There's a to-do list 10 miles long. I need time to just organize before I can even set my thought train on the tracks.
Andy Roark:
Well, I was like, “I'm going to use the last week of the year to clean out my office and get it all ready.” And I did the whole job where you get all the crap out and sorted into piles. And then, I ran out of steam-
Stephanie Goss:
And then, you put it back.
Andy Roark:
… and now, my office is unusable. I'm starting the year with a worse office than I had before because it's filled with the holy crap-
Stephanie Goss:
You and I…
Andy Roark:
… it's neatly sorted. But it did not get put away after I got it all out, and I emptied all the drawers out, and now, they're just sitting on top of the desk. I'm doing that.
Stephanie Goss:
You and I are so alike. Sometimes it's funny, not funny because a lot of the time, I have my camera with a blurred background on our meetings because my office is my master bedroom closet. And so, I'm in a tiny corner of the main bedroom closet and there's clothes all around me. And so, normally I have my background blurred. But this week, I have had it blurred for the same reason as you because I did the same thing. I'm like, “Oh, I'm going to clean, and I'm going to organize the things.” And I pulled everything out and now, there's just a pile. Like you, it's organized piles of crap. But there are literally piles of crap stacked up a waist-high behind me because it's a tiny little closet.
Andy Roark:
Oh, it's really-
Stephanie Goss:
Don't work for it to go.
Andy Roark:
… If you ever hear me talking about Stephanie Goss coming out of the closet, you'll think we're done podcasting. That's it. That's all it means. So, ridiculous.
Stephanie Goss:
Oh, man. Yeah, it's the beginning of the year.
Andy Roark:
I have a coping mechanism though. It's not healthy. But it's-
Stephanie Goss:
Oh, yeah?
Andy Roark:
… it's working for me. Yeah. Allison got me an espresso machine for my birthday. Remember that?
Stephanie Goss:
Yes.
Andy Roark:
I'm sucking those things down.
Stephanie Goss:
Just making more espresso.
Andy Roark:
Yeah. It's like it's water. And that's how I have made it through the first week of the year. It's going to be bad. I'm going to have a problem. I realized they make… The espresso people were like, “Oh, this is for people who sip coffee.” And I'm like, “I do not sip-“
Stephanie Goss:
I gulp.
Andy Roark:
… I don't say I don't sip. I do not sip.
Stephanie Goss:
So, what I hear you telling me is that I'm going to be waiting outside the men's room more frequently at VMX than normal because you normally already have to pee after coffee-
Andy Roark:
Yeah, totally.
Stephanie Goss:
… because you drink so much.
Andy Roark:
Yeah, I'm going to need… I don't know what the espresso to run-of-the-mill coffee translation is. I can be at liters now. I have no idea how much what my caffeine intake is. I drank too much yesterday. I felt my heart was going to explode. I felt awful. I had to ratchet back. Just in the middle of the day, I was like, “I feel horrible, horrible.” And I was like, “I can't see this again tomorrow.” So, I only tried two-
Stephanie Goss:
We have half-caff.
Andy Roark:
…double espressos.
Stephanie Goss:
We have-
Andy Roark:
Yeah. I-
Stephanie Goss:
Two double espressos.
Andy Roark:
… I only drink two double espressos, and now, I have a headache.
Stephanie Goss:
We have half-caff Andy for the podcast today.
Andy Roark:
Yeah.
Stephanie Goss:
Oh, man. Okay. Well, this one is a good one. You and I were having a conversation with some of our friends recently, and we were talking about team compensation. And where the conversation started going was in a really good direction, and I'm excited to talk about this with you. So, we had somebody who was saying, “I want to pay my team really well.” In fact, a goal for myself is to be able to say that I have the most highly compensated team in our metro area, right? I want them to have good pay, good benefits, feel good about where they're working. That is a goal for me as an employer. And at the same time, as a business owner, I want to make sure that I'm not pricing out the working families who are our client base from affording our services.”
And so, the conversation was really about how do you get the most out of the team? How do you leverage the team so that they are producing revenue that is helping raise the ceiling, particularly when it comes to team wages. And I just thought this will be a lot of fun to talk about on the podcast.
Andy Roark:
Yeah, no, I definitely agree. So, I super love this. I love this mentality. I've been thinking a lot about business in America in the last year, which sounds crazy, but it's true. I've been thinking a lot about business in America, and I consider myself to be a capitalist. I like the idea of people who work hard, get rewarded, and you take risks. And as a business owner, it makes sense to me, and I do like it. But I don't like all the ways that capitalism has manifested and has come to manifest in our country with this idea that capitalism means maximizing shareholder value. And when you have publicly traded companies, what that means is the job of the CEO is to make the most money for the people who own stock possible. And I go, “I don't think it has to be that way. And that's not what I aspire to.”
I think there's something really beautiful and wonderful about saying I own a business, and the goal is for me to get my needs met and to create a workplace that I'm happy to be in, and that I think other people are going to really love working in. And to pay the people who work with me really well, so that they have a good life, and they have income, and they have a nice positive environment to be in, and they feel like they're working with friends. I think that to me, that's the goal. That's the aspiration. It's not the maximize, maximize, maximize dollars to the stakeholders like that.
Anyway, that's just a bigger philosophy for me. But when I see this question, really, I just love it so much because it really speaks to what some of my values are of like. I want people to say, “Wow, that guy pays more than and pays better than anybody else.” I love that. I want that reputation. That's great. And I think it's great for us to aspire too. And so, then, you start to look at the nuts and bolts and you say, “Well, yeah, how do we actually do that?” And so, that's what I'm looking at today, and I start to think about this. When we get into headspace, and we start talking about things like this, and the question is really how do I use my technicians, so that we can produce the revenue that will raise their income. There's a couple caveats we have to put on the table up front.
Stephanie Goss:
Okay.
Andy Roark:
And some big things to just think about before we start talking about possibilities here is, number one, I believe that the future of vet medicine is fragmentation, right? And what that means is there's not our right way to practice medicine going forward. I think that when you look ahead at that medicine in 10 years, you are going to see a wild hodgepodge of different types and styles of that medicine that is just mind-blowing to anyone who's traveled here from the past 30 years ago when there was a basic… This is generally how we do vet medicine. I think those days are over, and there's just going to be a wild variety of ways that people are delivering services to pet owners.
So, when we start talking about these, no, I'm not saying that everyone should do them, and every practice is going to be different. And I think ultimately that's not a flaw, that's a feature. There will be people who just say, “We practice white glove, gold standard of care all the time.” And there'll be people who say, “We do high volume affordability focused medicine.” And there'll be people who say, “I'm a mobile vet, and I have one technician, and they work full-time with me,” and they'll be someone else who says, “I'm a virtual vet, and this is how I interact with technicians who are spread across the country.” And none of those are wrong. They're all just really different.
Stephanie Goss:
Yeah. No, I agree with that 100%. And I think we're starting to see that already like this. And that's one of the things that I think you and I do a lot, especially, lately on our personal views on social media, but one of the things that I love about social media is I really enjoy seeing the differences in our practices and seeing those different styles. And I tell you, there'll be times where I am scrolling through some hashtags on Instagram and I see what some practices are doing, and I see what their look is and how radically different it is compared to the practices that I have practiced it in. And the first thought in my head is, “That's freaking cool.” It's not, oh my gosh, I want to compete with that. That's really cool. I love what they're doing. I don't necessarily want to do that, but I think it's freaking awesome. And I think that there's a place for it with not only our clients, because we're not one size fits all. There have always been room for us to create our own cultures that are fit for client, also, let's think about it from the team perspective way to create different environments that suit different people in different ways. I just think it can only be a win I feel for veterinary medicine.
Andy Roark:
Oh, sure. I just want to put that forward because I know it's really easy. I've walked into lectures before and people say, “Well, this is what you do in your practice and blah, blah, blah.” And they go, “That's not what I'm doing.” And that I don't-
Stephanie Goss:
That's what you can't do in your practice.
Andy Roark:
Exactly. And so, I just think it's good too upfront to say, “We're going to talk about what's possible here, and know that it is not my belief that this is what everyone should do or where everyone is going.” And so, it's just… I don't know. This is going to be one of those buffet podcasts where it's like you need to walk along, you look at everything and maybe you'll pick up some things and maybe you won't pick up other things, and that's okay. This is what Andy and Stephanie think it should be-
Stephanie Goss:
It's the right answer.
Andy Roark:
… to have technicians, and this is the right answer. Yeah, totally.
So, yeah. I just want to lay that stuff out.
Stephanie Goss:
Okay.
Andy Roark:
There's some sacred cows that we're going to poke in this episode as well. And what I mean by that is these sacred cows are things that people believe you can't change that, you can't do that. That's not how it is. And I think it's important for people just to know, you need to think about what your sacred cows are when it comes to leveraging your staff. And the reason I say this is because a lot of us came up in vet medicine over the years, and there was a way that we worked, and there was a relationship that technicians had to clients and their assistants had to clients, and there were things the front desks did and ways that they did, and that was just how it was.
For example, some people really felt strongly that receptionists needed to be in the building, and that's not true. But to me that was a sacred cow is like, “Wait a second, the person who checks the pet on or out is not in the building. You can't do that. Yeah, you can. We have hospitals in Uncharted that do it. They have screens on the wall and credit card readers, and they have employee working from home with a logo of the hospital behind them. And that person just pops up on the screen in the exam room and checks the client out right there, and they work from home, and you go, “That's bonkers.” It wasn't that long ago the idea of an offsite phone center or phone room was just completely ridiculous, and it was heresy. It was like, “No, you can't have people who aren't in the building because they don't know what's going on.” And you say, “Well, that's not true.” And just because it's how we've always done it doesn't mean we always have to do it going forward.
And then, moving that closer to the topic at hand is the way that we use technicians and technicians the way they work under doctors. And you say, “Well, just because technicians haven't had autonomy before does not mean that that's not something that can't happen or can't be done very differently than what you've seen done before in your career.”
Stephanie Goss:
Yes. And I think for me, from a headspace perspective, it starts… I'm glad you talked about poking the sacred cow because that was a big sacred cow at the top of my list. And I think from a headspace perspective, I think we have to think about what are our limiting beliefs. And when I first started in veterinary medicine, and I feel really old at this point because it's been a lot of years.
Well, I think about when I started in veterinary medicine and the pervasive thought process was the veterinarians went to school, and they have the degrees, and they're the ones who generate the money for the practice. And that is still somewhat of a sacred cow in a lot of practices. And I think that it is, when it comes to this conversation, is very much a limiting belief.
And so, that's the first cow is who makes the revenue for your practice. And I would argue that in a lot of practices, even a practice where the primary revenue driver is, a doctor, there are things that if you really sit back and look at it. There is revenue that is being generated by the paraprofessional members of your team. And so, for me, it starts with what limiting beliefs might, I personally, might we, collectively as a team, might we, including our clients have about who actually generates revenue for the practice.
Andy Roark:
Yeah. Well, it's this basic idea that the technicians are backup dancers to the doctor.
Stephanie Goss:
Yes.
Andy Roark:
And that's how it's always been.
Stephanie Goss:
Right.
Andy Roark:
And the truth is that technicians can have their own show, and pet owners can be excited about that show.
Stephanie Goss:
Absolutely.
Andy Roark:
And it doesn't detract from the veterinarian show, it's just a different show. And I don't know about you. I watch more than one television show at a time, and sometimes, I need different things. Anyway, I don't want to stress the metaphor too far, but that's really the way that I think a lot of people have looked at technicians. If they're the backup dancers, and I, the veterinarian, and the main attraction, and I'm what people buy tickets to see, and I'd say, “Ah, I get it.” And that is how it used to be. It really is how it used to be. I don't think it's that way anymore, and I don't think it should be that way anymore. And I think our education system, the way we educate our techs has changed and continues to change in a way that makes that not necessary anymore.
And I would say that that model doesn't scale especially, when there's a shortage of veterinarians which means, if you can have a bunch of backup dancers, but you can't get a veterinarian to lead the show, then you're done. You're toast. Your business can't grow. The number of pets you can see is limited in that model. And so, I think starting to work through and say, “Okay, let's do this a little differently. Let's look at our technicians differently.” That's the sacred cow that you have to kill that cow in order to move into new pastures. I've lost my way on this metaphor to kill the cow, to take its pasture. And yeah, anyway-
Stephanie Goss:
It's just all Barnyard Math. It's hard at this point. Okay. So-
Andy Roark:
It's a murdering bloody barnyard-
Stephanie Goss:
So, we-
Andy Roark:
… metaphor.
Stephanie Goss:
We have to… I think the headspace has to start with poking some cows, which I love, and also, looking at what are the limiting beliefs like what do we think is possible or not possible, and then, can we flip those thoughts upside down, can we turn them sideways, what does that look like, and I think that's a big part of the headspace.
And I think the other piece of it going back to your thought about fragmentation is coming to the conversation, coming to this, even if it's a conversation with yourself in your head at this point, coming to the table with what could we do with the idea that if we just sit here and hallucinate for a second, what could be possible? How do you think that fragmentation has started to occur? It started to occur because someone had the idea, what if we had a model where we go to people's homes and we perform euthanasia at their home instead of them bringing the pets to the clinic? What if we had a model where we offered clients services that they might want while they waited for their pets at the vet? What if we combined two things together? What if we had a model that brought funds? There's a bunch of different things that people are doing, and it started with them not putting the stealing on themselves.
And so, from that perspective, I think the other big piece of headspace is let's just sit for a minute and think about what is possible. Because there's a ton of different things that we can do. And I'm excited to talk about the action steps here. What can we do? Where can we try and drive the revenue to answer the original question, which is how do we do things to help raise the ceiling? But I think a big part of it is about, let's think about what is possible.
Andy Roark:
Yeah. Yes. Let's think about what's possible. And some people are not going to like all of these things, but they are out there, and they are happening and there are things that we should start to tinker around with. This is why I said at the very beginning, some people are not going to be for them all the times, but when I start to look at the way that I see, not imagine, but the way that I see practices across the US and Canada using technicians, it varies widely in what people are doing and everybody's in different places. So, the most basic thing is tech appointments. And it blows my mind that some practices still don't offer technician appointments where people make an appointment to see the tech and not to see the doctor. Again, that's just the most basic level of like, “Okay, that's the first step in breaking your techs out.” But then-
Stephanie Goss:
Wait. But it blows my mind even more that there are more clinics that are doing tech appointments and not actually charging for them. So, they're offering it. They're offering it as a service, service for their clients, but they're not charging for the tech's time the same way that they are for the doctors.
Andy Roark:
Yes.
Stephanie Goss:
It blows my mind that this is still where we're at as an industry.
Andy Roark:
But that's a sacred cow problem. Somewhere at some level, I'm not a conscious thought at a subconscious level, someone's like, “We charge for doctor time. That's what our business is.” And I'm like, “I get it, and I know that that's been cooked in, but that's like, check your biases now because that doesn't make any sense.” But again, a lot of people, I think you're exactly right as they do these things and they're like, “Oh, we don't charge for that.” Look, we see the salaries of technicians going up and they should. Do some basic math. What does it cost? You're paying this person for an hour of their labor. What do you need to earn from pet owners in order to justify that salary? And how do you make it so that person earns that amount or brings in that amount?
So, it's got to work for everybody. But just the idea of like, “Oh, we don't charge anything for our techs, but we want to pay them a good salary, or we need to pay them a salary to retain them.” They go, “Well, that doesn't work.” But it's just starting to get out of there. I mean, technician productivity tracking I think is so important in the future. I'm amazed by how little of this we see.
The PIM systems, they really need to make it easier to look and be able to sort and say, “This doctor did this with this technician. And being able to sort well and look at your productivity by technician. That's how we look at our doctors.” And again, if we want to make our technicians productive and to pay them, and you and I have talked before in episodes about paying technicians on productivity, and you go, “Well, it works for doctors. Why is it taboo to talk about it for technicians and so…” But the first thing is that is you've got to measure it. You've got to see what your technicians are doing for you and come up with ways to do that.
Stephanie Goss:
Yeah and-
Andy Roark:
There's a…
Stephanie Goss:
… I would argue that that's actually not a technology problem. The technology is there. It's a sacred cow problem. It goes back to not charging for the tech time. We are choosing not to look at it collectively from a management perspective. The technology is there. I had that structure in my practice. We could tell you which technician, which assistant, who was in, what was in, who was in which exam that we could tell you time, we could tell you their production, all of those things, the technology is there, and it's been there for a long time. It's a sacred cow that it goes back to your thought about the vets are the lead singer and the rest of the team is the backup dancers. And so, we're consciously choosing not to set ourselves up for that kind of success. And I think that's the limiting belief. That's this we need to slay that cow and poke that there because it's not-
Andy Roark:
Display that cow for that. It's like old McDonald's farm up in here.
Stephanie Goss:
I can't. I need to say something about poking the cow, but I just said slay the cow so, I'm going to throw bears of this.
Andy Roark:
Slay the [inaudible 00:24:57] just slay, that cow-
Stephanie Goss:
It's barnyard.
Andy Roark:
It's barnyard. All right.
Stephanie Goss:
This is just going to be one of those podcasts.
Andy Roark:
Yeah, no, yeah. We're going to get better as the year goes on. It's just January. We're just breaking the ice. We're just getting loose for 2023. There's a company called BoosterPet out in Washington, state of Washington, something near you. And I don't know if you've seen this, but I actually did an interview with the founder on the Cone of Shame podcast that I do. And when COVID started, there were some changes to the patient client, patient, client, veterinarian relationship to help with virtual visits of things. And this person has started a practice where she opened up…
Basically, it's satellite practice, it's a wellness practice and it's staffed by technicians only. And there are big screens in all the exam rooms, and the doctor pops in virtually. And the whole practice is staffed by technicians. There's no doctor on site. That doctor appears in the room virtually, communicates with the technician who's doing the examination and the history, and they can back channel, communicate. They can go back in the treatment room and talk to the doctor privately, but they've got a doctor working virtually that's seeing all the rooms at this satellite practice. And there's no doctor there. It's only the techs. And the techs do everything, history, physical exam, vaccines, all the stuff.
The doctor appears on the screen, the technician and the pet owner are together, explain to the doctor what's going on. The doctor can see everything the tech has put into the medical records, and that's how they roll. And they turn appointments around, and they have online scheduling for the pet owners. And anyway, it's bonkers. If you want to learn more about that, keep an eye out on the Cone of Shame Podcast when that episode comes out. But again, this is not tech appointments. Every appointment is a tech appointment with the doctor coming in virtually to consult, to validate, to take a look at things. They've got video otoscopes where the tech can show the doctor what you need here and things like that. Okay, go.
Meg:
I love it so much.
Andy Roark:
It's incredible.
Meg:
I mean that-
Andy Roark:
I mean, incredible.
Stephanie Goss:
… that talks, that goes specifically to talk about two pieces, right? That is poking a sacred cow in multiple ways. The techs are in charge, the doctor is now the backup dancer, really in the sense that the techs are leading a show and they're running the thing, and it's poking some sacred cows in terms of technology that is highly, that is leveraging technology on a whole other level like I'm here for that kind of stuff.
Andy Roark:
It is, but it's not. Really at its essence, it's a Zoom call. I mean, it's not radical. I mean, I'm sure they have a fancy medical system that does it and its basic level. It's a Zoom call that we use all the time. And then, the otoscope, plenty of us have had video otoscope, that's not new. It's just the video's getting displayed 30 miles away-
Stephanie Goss:
But that's what I mean. That is taking that and turning that on its head, because that is the example where lots of people would look at that and be like, “That couldn't possibly work,” right? Because we can't think beyond a doctor has to physically be on the premises for us to practice medicine. That is a core foundational thing for veterinary medicine, and that is poking a sacred cow in a big way.
Andy Roark:
Yeah. Well, I like that you said technicians is, or the doctors the backup dancer. And that's another thing that I see that a lot of practices do as well is are you endorsing your technicians. Are you highlighting your technicians? Are you facilitating relationship building between the pet owners and the technicians? And again, I'm not saying you have to. I'm not saying that has to be your model, but there are a lot of practices that do. Well, I mean, if you're a-
Stephanie Goss:
I'm going to say you have to.
Andy Roark:
No, but I don't agree. I don't agree that you have to. I don't. In that, if you are a high volume, low-cost practice, it's about getting people in and getting them out and that relationship center maybe not-
Stephanie Goss:
[inaudible 00:29:26] to that.
Andy Roark:
It's necessary there, but I would say the advantages of this are pretty significant and substantial. So, one, it's good for the technicians having people request the technician that they want to see. That's good for your business, it's good for your practice. It builds that relationship. And the other thing is you're a doctor. See, I think initial reactions from doctors that I talk to are usually they recoil and go, “Oh, no, I'm the one.” It's a little jealousy, right? It's a little bit of jealousy.
Stephanie Goss:
It goes back to your metaphor about the doctors being like fighter pilots. There's jealousy there. It's like there's a… They're the head honcho. They're the big man on campus and they're definitely-
Andy Roark:
They're the lead singer.
Stephanie Goss:
Yeah.
Andy Roark:
They're the lead singer. What do you mean? They don't want to see me. They want to see someone else. So, they recoil oftentimes. Sometimes they stay recoiled, and they're just like, “Nope, my ego can't handle this, or this is just not the practice I want to work in.” Which is fine. I'm not going to argue it. Like I said, there's a lot of a pass.
Stephanie Goss:
That's a form of fragmentation, really. There's a place that fits. If that's how you feel, there's nothing wrong with that. There is a practice for you that isn't model.
Andy Roark:
Well, imagine for a second that… And again, just put people's fears at ease when we talk about things like this but imagine for a second that became the norm. You better believe that there would be practices that would then say, “At this practice, you only talk to the doctor.” It would just like, “It's not,” and you're not going to get exile.
No. It's never going to be like, “I don't want to talk to the doctor.” It's not going to happen. But what often brings doctors around is this idea of like, “Hey buddy, think about what you do with your day. Think about how much communication you do. How nice would it be if the pet owner knew someone else at the practice that they felt comfortable with and connected to? How would that be good for you as you try to get through your day and get things done?”
Stephanie Goss:
I'm going to maybe blow some doctor minds for a second because I want you guys to hallucinate with me for a second. So, Andy, imagine that you'd been seeing a full… Your Dr. Andy hat is on. You've been seeing a full day of patients. And imagine instead of having to end each exam with, you're still going to ask them what questions, “Do you have that we haven't answered? Is there anything else?” And to be able to say, “We're going to have follow up on these labs.” Stephanie's my technician today, her info is going to be on your invoice. She's going to give you a call, or someone on the team that she's talked to is going to give you a call in a couple of days when the lab work comes back, and this is the plan.
And then, now, instead of the stack of all of those calls that have come in from clients who are like, “I have a question for Dr. Roark. I was there two days ago, and I have questions that I need to ask him questions.” Instead of dealing with all of that, you have offloaded a lot of work when it comes to client communication off of your plate. And you're empowering your team to take the lead, to take an interest in their cases. You are creating a patient and client bond for your team as well. And let me tell you, it is a game changer for everybody.
Andy Roark:
Oh, absolutely. No, that's it. That's what we're talking about, right? It's setting expectations. It's just thinking creatively about like, “How do I spend my time, and what can my technicians do to help me? What are services of value?” And you say, “Well, how does the technician doing these callbacks? How does that increase their value? Because they're not seeing patients.” And I would say, “Well, if your doctors aren't doing this, they should be able to pick up more… There's other things they do with their time.” They're either adding more appointments because they're not having to do this maintenance and the communication. Let's be honest, it's hard work. It's mentally draining work. Is that client communication? It takes time and effort and mental energy. And so, you can possibly pick up more appointments, but what's more likely is you're probably spending a little bit more time with the clients that you have. You're probably recommending that dental cleaning when in the past you would've said, “Those teeth are… they're okay for now, and I don't have time. I'm running behind. I'm just going to say this is good enough and go on.” Which of course, no one ever has thoughts like that when they're busy.
Stephanie Goss:
No, never.
Andy Roark:
But yeah. You get it.
Stephanie Goss:
Well, and also, they're generating the revenue that didn't get generated in the exam room. So, how many times have you, Andy, had a conversation with an owner and you're like, “You know, we really should do a dental, and there's all like this. There's five other problems. So, let's start here.” And when you build the relationship for the technician to then be empowered to have the follow-up with the owner. When the owner calls in and has the questions, and the technician or the assistant can spend the time on the phone with them that you didn't have in the exam room, and they can answer those questions. And now, the recommendations you made that were declined the first time, they're generating that follow-up revenue because now, they have answered Mrs. Smith's questions and now, she's going to bring Fluffy back to do X, Y, and Z that was recommended, that was declined at the first visit.
So, you, as the doctor generated the idea of that revenue and your recommendations as you should from the medical perspective. And the revenue still walked out the door when Mrs. Smith left that day. And it's being generated when the team has that follow up and says, “Well, it looks like in the chart Dr. Roark was recommending that we do this and this. What questions do you have that I can answer for you about those recommendations?” And when they get Mrs. Smith back in the door, that's revenue that is coming back in the door that wouldn't have necessarily come back in the door otherwise.
Andy Roark:
What do you think about tipping the team? Talk about sacred cow. People recoil from that. There's not many places that I go now that don't ask for you to tip the staff, and I'm not saying I agree with it. Okay. So, the most benign example is there's numerous counter service restaurants that I go to where I stand at the counter and I order the food, and then, they call my number and I come and get the food. And they still ask me for a tip, right? When I swipe my card, they're like, “Would you like to give us a tip?” And I'm like, “A tip for what? You made the food.” But then, I press $1 every time because I don't want to be a guy like, “Oh, well, I'm trying to help these guys doing the work, share the wealth and just…” I'm fine, especially, I don't want them to spit my food, so I'd give them a tip, but there's that. But then, if you get a massage, you get your haircut. I go and get my haircut and they're like, “This is what a haircut costs.” And I'm like, “That's ridiculous. I'm not that old. I remember when the haircut was 10 bucks, and then, I'm like, “This is what a haircut cost-“
Stephanie Goss:
I was waiting.
Andy Roark:
… are you freaking kidding?
Stephanie Goss:
I was the waiting for the walking backwards uphill both ways in the snow with no snowshoes on story. I was waiting for it. Okay. It's haircuts. All right. This is where we're at.
Andy Roark:
So, that means, I know I'm not the only one who's had this experience. But anyway, you've just get the haircut and they're like, “The default is a 20% tip.” Which is like $8, and I'm like, “An $8 tip on a $35 haircut which there's no hard cost. It's just you and some scissors.” But it's the norm, and it's clearly been normalized, and people clearly give tips. And so, anyway, I'm kicking those things around. I do escape rooms with my wife and they're like, “Oh, it's not cheap to go book an escape room. But then, when you're done, you better believe they're going to ask you to tip the staff who was involved and gave you the lecture and blah, blah blah.” And I go, “Man, I'm not arguing whether or not this is how society should be because that doesn't make any difference.
But I do look around and at some point, you say, “Is tipping for service ubiquitous in our society?” And if it is, is it ridiculous to allow not let me own courage, but just facilitate pet owners tipping the technicians and receptionist, the support staff for the extra care? How many people who have hospitalized pets and feel the support staff did-
Stephanie Goss:
Go above and beyond.
Andy Roark:
… an amazing job, above and beyond how many of those people would be like, “Here's 100 bucks for the staff.” And again, I'm not really endorsing this. But I am honestly, I need to think about it more. But again, sacred cow, you go, how dare you tipping for a medical service that's heresy. And another part of me goes, I mean, I don't know. It seems pretty standard. It's pretty easy to do when people are paying with credit cards. They can decline the tip if they want. Is this a thing? And I honestly asked the question, what kind of revenue would that be? I'm sure people have done it. I'm just curious. Are we talking about, is that $500 a week for the whole paraprofessional staff, or is that $500 a day for the whole paraprofessional staff that worked? Or is it more than that? I have no idea what we're talking about. But I don't know. Again, I'm not endorsing it, but if a lot of other industries are using tipping to supplement the income of their frontline workforce.
Stephanie Goss:
Yeah. It's an interesting argument for sure.
Andy Roark:
I'm honestly not pushing forward it. I'm asking-
Stephanie Goss:
Yeah, it's a good question.
Andy Roark:
… I'm asking a question.
Stephanie Goss:
It's a good question. It's a question to ask.
Andy Roark:
I'm surprised I haven't seen in that mess, yeah.
Stephanie Goss:
Because it is a sacred cow for sure. It is one that's worth poking.
Andy Roark:
Yeah, [inaudible 00:39:47]. All right, let's take a break, and then, we'll get back and we'll just get into some extra stuff real fast.
Stephanie Goss:
Okay.
Hey, it's Stephanie, and I'm jumping in here for one quick second because we have a workshop coming up next week that you are not going to want to miss. Our friend and colleague Maria Purita CVPM is going to be leading a workshop that is open to the public and to our members on February 15th, 2023. It is at 8:00 PM Eastern, 5:00 PM Pacific, and it is called texting it to the next level. That's right. Maria is going to be tackling, talking about some of the dos and don'ts when it comes to texting with our clients, and really how to take what we all jumped in and started doing full tilt during the pandemic and use it to level up and build a stronger bond with our clients without lengthy phone calls. And hopefully, save you and your team some headache and some time and some stress and recoup that time back into your day.
So, if this sounds like something you'd be in on, head on over to unchartedvet.com/events. Check it out. If you are a member, you always get in for a free. If you're not a member, you can join. It is $99 for this workshop or check out an uncharted membership because you get all of the workshops that we do in the course of the year at no additional charge with the cost of your membership. So, check it out, unchartedvet.com/events.
Now, back to the podcast.
Andy Roark:
All right, let's get into action steps-
Stephanie Goss:
Okay.
Andy Roark:
Sound good?
Stephanie Goss:
Yes.
Andy Roark:
All right. I've got three major categories. I think there's three levers you can pull if you want to set your technicians up to generate more revenue, okay? So, you can make them more effective in their current role. You can free up their capacity so that they can get more done, and you can add new services that they can perform to generate revenue. Those are really the only three. I have a fourth one that we can change the relationship that our paraprofessionals have with the pet owners, but I think that falls under making them more effective now. Does that make sense?
Stephanie Goss:
Uh-huh, it totally does. So, I agree with that, and I'll roll it back one step further so zooming all the way out and looking at the question of how do I get the most out of them, so that we're producing revenue and we can raise this. How do I raise the ceiling on staff wages when we zoom all the way out? We look at it from a business perspective. This is a simple math problem because we can control our pricing, we can control our volume of patients that we see, and we can control our costs in other areas or some combination of those three things. But from a business perspective, that is how we control the revenue that is being generated from our practice. And so, I think it has to start with looking at those three things and figuring out what amount of pressure are we going to apply in which category.
And there is a school of thought that's like, let's just cut our other costs. At some point, we can only be efficient and effective… At some point if we cut everything off of our shelves, we don't have the tools we need to do our job. So, when you look at each of these, and I think that's why I love the question that got asked in the conversation we had because this practice owner was like, “I'm acknowledging that. Yes, I need to be pricing appropriately because that's one of the three options. And if I solely leverage the increase on pricing alone, at some point, I will price clients out of my services.”
And this is a core value. We want to serve the people that we are serving. And so, I know that that can't be the only lever that I am pushing on. And so, how do I take those three things, the pricing, the volume of cases we see, the cutting costs, and then, looking at those three things and deciding where I'm going to apply pressure and in what combination, then how do we roll it down at the next level, which is your level of what do we do with the team, and where can they help us apply pressure on those three levers. Their efficiency, their effectiveness, those things directly influence those three levers above in terms of pricing and volume and cutting costs.
Andy Roark:
Yeah. If you're interested in that type of cost cutting, pricing, things like that, I just did. It was the last episode of Cone of Shame Podcast of 2022. So, it was like December 27th or something. It's called the Art of Pricing Veterinary Medicine, and I interviewed Fritz Wood, who is, I a mentor of mine. He's amazing. But you want to hear a 40-minute conversation on, basically I said, “Pretend I'm a practice owner who's coming to you and saying, Fritz, I really need to bridge my prices. Walk me through that process. What advice would you give me? What would you tell me to do and not do?”
Stephanie Goss:
I love it.
Andy Roark:
And so, if you're like, “Oh, what does that look like?” I got a whole podcast with you. It just came out a couple weeks ago. So, you can check out Code of Shame. It's called the Art of Pricing Vet Medicine. It was out at the end of December in 2022. But it's definitely worth listening to.
Stephanie Goss:
So, I think it starts there because that's a simple math problem. You cannot apply math to this problem. You have to look statistically at how are you going to apply the pressure on those three areas, and in what order, and that's a decision. That's where you have to do you. And there's not going to be a right answer. And first, would tell you that there's not one right answer that is going to solve that everybody's problems. It has to be the makeup of your practice, the makeup of your expenses, all of those things have to be taken into account. So, if you start at that layer, and then, if you go down to the next layer which is “We're asking this question because of the team. We're asking because we want to compensate our people. We care about them. We love having them work with us, and how do we that? And so give me your list again.”
Andy Roark:
Yeah, so getting more efficient at what you're doing. And so, what I would say then is this is a way of not raising prices. It's about getting better compliance from pet owners for about making them trust the practice more, feeling more comfortable, understanding the services that we recommend and why we recommend them, things like that. So, it doesn't mean that-
Stephanie Goss:
Is that effective or efficient?
Andy Roark:
Say what?
Stephanie Goss:
Is that effective or is that efficient?
Andy Roark:
Oh, both. Well, efficient is seeing more pet owners.
Stephanie Goss:
Yeah, that's what I was going to say. I would say that's effective, and if you're effective, you're going to drive more revenue.
Andy Roark:
Right, so getting better at what we're currently doing-
Stephanie Goss:
Okay. Love it.
Andy Roark:
… is that right? So, you're talking being efficient is moving through more cases, but being effective, like we talked about with endorsing pet owners or endorsing technicians-
Stephanie Goss:
The team.
Andy Roark:
… things like that. You can build better relationships. We can empower our paraprofessionals to make basic wellness recommendations or talk about these products and services. We can stop and train them to be more effective in the exam room. And this is a simple thing that any team can do. It's just about saying, how do we say this? How do we build trust? How do we get a good rapport? How do we build rapport in the first 30 seconds when we walk into the exam room? Have you trained your staff on that? I mean, honestly, how important is that? It's vital important. It makes this huge difference over time, just being able to connect with clients to know how to recommend wellness care, to know what's going to happen in the practice to do all those things. And it's amazing to me how many practices actually say, “Guys, let's get together and let's talk about how we do this. And let's get on the same page. We just throw people in there.” And so, that was one of the reasons. So, quick, honest to God plug.
I made a team training course called exam room communication toolkit. It's at drandyroark.com. It is made for your team to watch together. It's broken up into little five minute modules, so you can just pick one and say, “I'm just going to show this video to the team,” and then, there's discussion questions, and I'm going to ask the team the discussion questions, so that they can talk about what they do, and what works well, and share ideas and best practices.
And I tried to make it so easy to just get your team together. It can be just your text, it can be just your front desk. Pick a five-minute module, pick two of them, do them, talk about them, and watch people just raise their game by hearing what their colleagues do, and what works for them. It is so simple, but people just… we don't train on what to say in the exam room and it baffles my mind. So, really, I was like this, “There's got to be something that can help people.”
So, anyway, exam room communication toolkit, it's at drandyroark.com. You can definitely check that out if that's something that you want to do to pull that lever.
Stephanie Goss:
And I will tell you, as someone who has tracked team production, the efficacy of that training your team what to say, and how to say it in the exam room and looking as a collectively as a team on what client education, what standard of care medicine we want to have as a whole. And then, teaching the team how to deliver that messaging and taking some of the weight of that off of the shoulders of the doctors, I will tell you that our practice went from very low six figures for revenue that was generated from preventive medicine like flea, tick, heartworm, heartworm testing, fecal testing, et cetera. And when we really focused as a team and as a hospital on making sure everybody on the team understood what our standard risk care was, what we were recommending, why we were recommending it, and then, trained them how to have those conversations with the clients.
And we restructured our process to empower them and put that on them because to your point, the doctors were busy man. And they were trying to be like, “Okay, there's like 10 problems here in this visit. Let's take the top three medical issues and focus there.” Who has time to talk about the fact that, yeah, they see their journey that they probably actually need a dental? When we focus on that, the revenue that was being generated by the paraprofessional team and that regard went from that low six-figure number well up over the seven figures. And it makes the huge difference. And it is all about the mindset and about looking… deciding what you're going to do and how you're going to do it, and then monitoring it to your point. If you're tracking that, it is amazing to watch. And it's really exciting as a practice owner to then be able to look at that and be like, “Holy cow, you guys hit the mark here, and now I can give it back. Now I can pay it back. Now I can give everybody raises. Now I can have bonus programs,” that kind of stuff. So, I think that's super empowering.
Andy Roark:
Yeah, the second one was capacity. And it's just trying to figure out how do I increase the capacity for my technicians to do good to see pets? I mean, at some way this distills down often. This is just, are you using your technicians at the top of their licensure? Are they doing the most advanced, most valuable things that they are licensed in your state to do? And if the answer is no, they're holding dogs, I'm like, “Man, you are not using them in the capacity that they can be leveraged.” And so, just stop for a second and go, “Are we using our techs the right way? Are we using them at the top of their licensure?” It's pretty much just worth every practice looking at what your state allows registered technicians to do. And that makes it hard for me and Stephanie to talk on the podcast about do exactly this or do exactly that-
Stephanie Goss:
Because it's so different.
Andy Roark:
There's so different between states. But look at Washington, what I was just talking about and the BoosterPet that's like, “There's not a doctor in the building, they're just on the screen.” Washington is one state, a state. Your state is probably very different. But are you leveraging your technicians in the way that makes sense given the restrictions that you're working under?
Stephanie Goss:
And I think from the brainstorming idea, that's knowing your practice act and knowing what you can and can't do, and then, also looking at what else is included in other states. And so, there's some great resource material out there through AVMA. There's a tech skills list that basically the schools that AVMA certifies as being tech training programs have to have a certain list of skills that they have to say, “Yes, we are teaching them, and this is how we're teaching them how to obtain these skills.” And so, looking at that skillset list and trying to figure out what could we do, getting some idea, don't try and reinvent the wheel. Come up with some ideas from there and either, like you said, Andy, there's going to be things that you can't do in your state, but it gives you a place to start brainstorming.
Andy Roark:
Exactly. Yeah. I mean, in the capacity as well. It's like, “Do they have to be in the building? Can they work from home? Can we leverage them virtually to see… to interact with pet owners in a meaningful way?” In a way that pet owners will see value in. Or whether they're paying for it directly, or whether it's taking work off of the vet's place, either one.
The other part, the last part is new services. Are there things, are there services that your technicians could perform that are not currently being offered as technician services? And the answer is we say, “How do you keep prices down and make techs more valuable?” Introduce new services that are priced fairly and appropriately and that the technicians can add to the menu of things that you're already doing. And so, that's tech appointments. Things like we said, if you have tech appointments, you're not charging for them. That doesn't make any sense because the techs are getting paid. They're on the clock. That doesn't make any sense to me, but I do see it as well. Are there technician wellness appointments? Do you have boarding in your facility? If you have boarding, are there opportunities for technicians to work with pets and boarding that pet owners would see value in and would opt into and things like that. There's just the sky is the limit, really. It's really about looking at services that you could offer to pet owners and seeing about what would pet owners see value in.
Stephanie Goss:
And I think that's another one where, again, just thinking about it from the no ceiling perspective, and I'll tell you my practice. We got ultrasound which we had not had previously in the practice, and we got ultrasound with the intention of the team was going to do this thing, not the doctors. And the team got trained and certified as ultrasonographers, and then we leveraged technology to have it read by board of specialists and be able to give the doctor a full report and say, “This is my recommendations as a specialist in this case area.” And it was a whole new area of service and revenue for the practice. And it was driven by the team, and it talk about empowering the technicians, teaching them, continuing to grow them and their education, but also, bringing new services in. And so, I think it's about looking at it from an open minds perspective. And so, I agree with you.
My last step is, look at what you can and can't do as far as your locality, but then, also, dream about it on your own, but also, with your team ignoring the ceiling. Let's put aside the limiting beliefs. Let make a list, and then, pick a couple. Don't try and eat the whole elephant. Make a giant list and be like, “What is one or two or three things at the most, things that we could try, that we could act? Can we start charging for tech appointments? Did we buy a laser, but we've never really focused on doing it? Can we get somebody trained? Can somebody on the tech team start offering laser services?” Whatever that is, whatever it looks like in your practice, pick a couple of those things and then, start to do them. And when you're doing them consistently and effectively and you're monitoring that revenue growth that's coming in, add a couple more.
Andy Roark:
Yeah. Canine rehabilitation is one. I've seen technicians just blow up. It was like, “Oh, we don't have time for that.” And I was working with a practice in New York, and they had a technician who got all fired up at CE, and she had a practice manager who bought into her and said, “What? If you want to try to make this, go I'll give you a closet, and you can work. I'm serious and you can work as closet.” And now, they're currently building a new building for her, and it's because she blew it up but it's true.
The last thing I would say is, and I'll be done, but if you want clients to trust your technicians, you have to endorse your technicians. You have to lean into building the technician brand. And people say, “Oh, the pet owners don't want to talk to the tech. They want to talk to the doctors.” And I'll say, “Well, that's because you have not convinced them of the value of the technicians, which is a problem that you can address.”
It takes intentionality. It's one foot in front of the other, but it's intentionally featuring your technicians, facilitating their relationships, talking to the pet owners about the technicians, giving the technicians some weight in the conversations. And when we talk about their value and their expertise, setting expectations that the pet owner will talk to the technician. It's all of those things, and they're subtle things. But people want to know that they're talking to someone who is competent, someone who has the power to fix their problems and to help them. And if you convince them that the technician is competent and has the power to fix their problems, they will be happy to talk to the technician because it's a whole lot easier to get the technician on the phone at least it should be.
Stephanie Goss:
Why you got to go open a whole soapbox.
Andy Roark:
I know we got to go. We're out of time.
Stephanie Goss:
At the end of an episode, that needs to be its own episode, Andy Roark. Because I have so many thoughts, but we're done for the day. We're going to do that. You realize that now you've opened the can of worms. We're going to have to do that as an episode.
Andy Roark:
I'm going to need another espresso before we do.
Stephanie Goss:
Take care everybody. Have a fantastic week.
Andy Roark:
See you everybody.
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.
