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Jul 05 2023

I Can’t Afford to Give Them All Raises

Uncharted Veterinary Podcast Episode 239 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are in the mailbag to take on a question from a practice manager colleague who is struggling with hiring. They have a candidate who feels like a good culture fit. This is a huge win and probably has you wondering “What is the problem???” Well, this candidate is a good culture fit and they are less skilled than the manager's current assistants. And they are currently making a wage that is both higher than the existing assistants AND over the top end of this practice's pay scale. The manager is wondering what to do but more so, how do they know when it is time to adjust the pay scale? Because they thought they were paying well. This sparked some lively discussion between Andy and Stephanie. Let's get into this…

Uncharted Veterinary Podcast · UVP – 239 – I Can't Afford To Give Them All Raises

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

Submit your questions here: unchartedvet.com/mailbag


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Episode Transcript

Stephanie Goss:
Hey everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, Andy and I are jumping into a letter that we got in the mailbag from a manager who has a good cultural fit assistant candidate that has been working for another vet in town. And this assistant is making quite a bit more money than this manager's existing assistants. And they are wondering what to do about the situation, but their question isn't what you might think given the situation. This was a really fun one for Andy and I to debate. Let's get into this, shall we?
And now the Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and the one and only Stephanie I guess the change in my pocket wasn't enough Goss. Ah,

Stephanie Goss:
That's funny. I was like, where's he going with this? And then…

Dr. Andy Roark:
Then you got it.

Stephanie Goss:
And then I realized where you were going with this.

Dr. Andy Roark:
Ah, then you got it.

Stephanie Goss:
How's it going?

Dr. Andy Roark:
It's good. It's good. Yeah, things are good. I can't complain. I've been doing the driver's ed with my daughter where she has her learner's permit and so we go out and we drive. And so yes, last night she was like, “All right, we are going out on this big…” It's like it's five lanes in each direction, a big road. And she's like, “I'm doing it.” And my mom was down visiting and I think she wanted to show her grandmother what a good driver she was. And so she was like, “I'm not afraid. We are going out past Target on the big road.” And so she gets in the big road and she's in the center lane and we're just driving and we just keep driving. And finally I was like, “Jacqueline, where are we going?” We've left Greenville, like we're leaving Greer South Carolina. We're in different county.
She's just driving on this big road always in the center lane. And she's like, “No, I'm going to turn around and we just keep going.” And I was like, “Jacqueline, what are we doing?” And I realized that the traffic was whipping by and she was afraid to change lanes and so we were trapped in the center lane of this big road because every time she would like… And then she really started to feel pressure and so she'd put her turn signal on and people were just kind of jerks.
And they would just move into her blind spot. We went another 15 minutes before she could get out of the middle lane. And it was one of those things where you were like, I wanted to be “Jacqueline for God's sake, figure this out.” But that doesn't help the 15-year-old girl who's driving the car-

Stephanie Goss:
Poor Jacqueline.

Dr. Andy Roark:
… feeling a lot of anxiety and she desperately wants to do everything right. And so giving her a hard time is not helping. And also we should apply some pressure here. So I did what I do, which is just lean into humor and I started texting people that I was glad to have known them.

Stephanie Goss:
You're never coming back because you're going to be stuck in the middle lane forever.

Dr. Andy Roark:
Exactly right. I was like, “Tell Hannah her father loved her and I'm sorry I wasn't there for her 12th birthday, but just know that somewhere I'm still driving in the middle lane.” At that point I was probably somewhere around Milwaukee.

Stephanie Goss:
Oh man. Hey listen, I've driven out by your Target and it is crazy. So-

Dr. Andy Roark:
It is crazy.

Stephanie Goss:
… I don't blame her.

Dr. Andy Roark:
No.

Stephanie Goss:
Okay. I hate that part of town.

Dr. Andy Roark:
No, just the whole thing reminded me of European vacation with Chevy Chase-

Stephanie Goss:
That's so funny.

Dr. Andy Roark:
You know when he's stuck in the roundabout?

Stephanie Goss:
Yes, yes.

Dr. Andy Roark:
I'm like, “That was it.” So the roundabout was just a straight road.

Stephanie Goss:
That's so funny. So I had my first driving experience with my kid this last week. Now she does not have her learner's permit yet. She's 14.

Dr. Andy Roark:
So you're just breaking the law.

Stephanie Goss:
Yes.

Dr. Andy Roark:
Okay.

Stephanie Goss:
But I was on our property.

Dr. Andy Roark:
Okay. Was it like a lawnmower driving experience?

Stephanie Goss:
Nope. Nope. She's done that. She's done the golf cart. So we progressed to an actual car and I had to move the cars around in the driveway and I was like, “Sissy, do you want to want to back the one car up and then we'll move the other car and then you can drive it back up the driveway.” And she was very excited.

Dr. Andy Roark:
Yeah. This sounds like an idea I would have. This is 100% sounds like an Andy Roark idea of-

Stephanie Goss:
Mow my driveway is-

Dr. Andy Roark:
Just going to get her to park down the driveway. What's the big deal?

Stephanie Goss:
My driveway is not as steep as your driveway, but it is steep and it does have a ditch off to one side. I did not learn my lesson from listening to you talk about Jacqueline, however, there was no falling off the side of… She did great. But what I is, my poor kid is going to be the kid who's literally in a booster seat to drive. She is my grandmother.
Our driveway is steep. And so it's hard enough when you're short to see over. I am very short. It's hard enough to see over the dashboard when you're short. Going straight uphill when you're short is a significant challenge. And bless her heart, she was just creeping because she's like, “I don't want to crash into anything.” And I'm like, “Thank you for not crashing my car, but also can you step on the gas?” Taking 20 minutes to go up the driveway. Oh. But it was that moment of “I'm not ready for this.”

Dr. Andy Roark:
Yeah. Oh, it's a whole… Yeah. The joys of parenting never end. But you know-

Stephanie Goss:
I'm not ready.

Dr. Andy Roark:
… philosophically it's funny. That's life in a lot of ways because we don't give ourself enough credit for the hardships that we've overcome. We were all there at some point where we were freaked out to change lanes and now we don't even think about it, but we don't go back and pat ourselves like “Yeah, I got past that.” We get past it and we go on, but it's just funny that that's life. And so I really love where my daughters are right now sort of developmentally in that I'm watching these wonderful people figure out what it means to be an adult human being. And the challenges they're facing are challenges that I can relate to. I get traffic stress, I get it. I didn't necessarily get… I can't find my video I want towatch on YouTube anymore.
That was not a part of my childhood that I relate to. But the stuff when they start acting like real adults, I'm getting it. And so Jacqueline, I think she's going to do some work for us over the summer at Uncharted probably doing some website stuff and some data management stuff, which is sort of an interest of her, but she has to interview for the job. And so she's going to come meet with Tyler and Stephanie-

Stephanie Goss:
I love it.

Dr. Andy Roark:
… and Danielsson and she's going to have an interview with them later this week. And so she's stressing about her job interview at her dad's company.

Stephanie Goss:
Oh my gosh, that's so funny.

Dr. Andy Roark:
But I'm enjoying it. So it's awesome. It's awesome.

Stephanie Goss:
I love it. I love it. Well, I'm excited about today's episode. So we had a mail bag that I just loved and it was from a manager who was struggling because they have a good cultural fit candidate who has been working for another vet in town who is older and getting ready to retire. And they've been with that practice for a long time. And so this assistant unlicensed is making more than the high end of this new practice's assistant pay scale. And so the manager was like, “We have good culture, it's a good environment. There's lots more opportunities at our practice, but when I just look at the finances, this assistant would be taking a pretty significant pay cut to make the change over to our practice.” And they were like, “I really don't feel like I can justify paying them more than the current assistants because my current assistants have more skillset than they do.”
So this is an experienced assistant, but they have a lower set of skills because they have not been doing the same level of things in their current practice. And so that's the backstory. But what the manager was asking was that this made them reflect about their current hiring process and they were like, “I'm worried that I'm not attracting good candidates at our current pay scale, which I thought was pretty competitive and I'm looking at increasing the whole scale, but I have no idea how to tell if I can actually afford that, when I can afford it, how I can afford it.” And they were like, “I've raised prices and I'm planning on a significant price increase again, but how do I know when I can afford to give people raises essentially by increasing my pay scale?

Dr. Andy Roark:
There's a couple of things here. So let's start with head space in general. And so I want to immediately push back on where this is going and just, I'm not saying… Just hear me in terms of head space is where we provide context and we try to zoom out and look at the whole picture. And so one of the things that I want to say, and there's some baseline assumptions here, I think this is interesting. I understand this is definitely coming from a place of privilege, but just hear me out. There seems to be this idea in our culture that as you go through life, you will always make more money. You will make more money and more money and more money. And the idea of making less money than you made before is somehow innately a failure. And I see that a lot and I kind of look at that idea and I push back on it a bit.
Now, I'm not saying I think this sounds a lot differently when we're talking about people who are not making a living wage or things like that. But I'll give you an example. I saw there was this consultant in our industry, he's in vet medicine and he does a bunch of positive psychology and stuff like that. And he's not associated with Uncharted in any way, but his business was growing and he wanted to hire another consultant. And he said, “I'm looking for a young consultant or someone who doesn't have experience. And I would train them and help them and they would work with me and this is a position that we would like to grow.” And he could pay the person something like $60,000, right?
And then I saw a discussion of this in some of the manager groups and stuff in Facebook and uniformly, they were like, “This is offensive that he would offer this job because we make so much more now doing what we're doing managing this hospital. It would be a massive pay cut to go and do this.” And some people were really upset that this job offer existed. And to me, I just sat and looked at it and again, this idea that you have to move upward in pay in your life continuously. I don't think that that's true. And I think it's possible that this person who wants to hire and grow a young consultant and says, “This is what I can pay.”
I don't know that it's about worth or someone says, “Oh, you're not worth that or anything.” It's just a simple matter of this is the opportunity that “We have and this is what it pays. And you have to factor that into your decision of do you want to do this work or not.” And as someone who owns his own business, let me tell you, I have not made more money every year. That has not happened. There's good years and there's less good years. You know what I mean? And I could tell you the first year that I stepped back from being full-time in practice to try to do some of my own weird writing and speaking things, my pay went down. And that's not failure. That's just me saying I'm not being a full-time doctor anymore. I'm being a part-time doctor and I'm doing these other things and that job just doesn't pay as much as the other job.
And again, so there's not anything right or wrong about it and I hope people aren't hearing this the wrong way. My whole point in this is just if this person is a great fit and they think that they would be a great fit and you have a really good opportunity for them, they don't necessarily have to make the same money that they made in their last job in my mind, to come there. I will tell you, I have worked at a couple of places that I would take big pay cuts to work at because their culture was great. And I would say, “Yeah, I get it.” And again, all this is based on I had my needs met, my wife works full-time, like I get it, that's not everybody. But the idea, just this is part of pay scales. If you put pay scales in place, the benefit to pay scales is wage transparency and people kind of know what they make and you get some standardization.
The downside is that sometimes people are going to come and they're going to say, “I'm worth more than what your scale has put in place.” And that's their perception of what they're worth. But they're going to say that and then you are going to feel trapped because you either have to change your scales, which has a big weight attached to it, or you're going to have to say to the person, “I'm sorry, this is what I can offer you based on the scales that we established.” And sometimes I think people think that that's a deal breaker right away. Well this person said “That's what they're currently making and I can't offer them that, so they're not going to take the job.” And I would say “Maybe that's true.” I think that if it saved me 25 minutes of driving in each direction and I was coming to work at a place that had a great culture as opposed to a toxic dump, I would take a rather significant reduction in pay to have that job.
And so anyway, I just want to kind of open up with head space and say, I don't think that we're obligated to match someone's current salary or to give them a raise as they come in. If we have standard pay scales and we have a good reason or just say “This is what we can do,” that doesn't make us bad. And again, the person might not take you up on it, that's their right and their prerogative is to say, “No, I really need to make what I make now because that's what my budget is on.” And that might be a deal breaker for them.
But anyway, I just want to start with that and say just because you have someone who you think would be a good fit and they don't match up with your current pay scale, that's not necessarily the end of the world. It's something that you would need to talk about with that person. But I always put that forward because I feel like people think that it's an assumption that's chiseled in stone is whatever the person has made before we have to match that. And I don't know that that's true.

Stephanie Goss:
Okay. So much to unpack there. So two things I want to pick apart. One is I totally agree with you on the taking a step sideways in terms of pay for the right position. And I think that that is totally true and I am 100% on board with that. And I think for a lot of us being in veterinary medicine, we have historically, when we're talking about the paraprofessional staff, we have historically a lot of, I would say as a whole grossly underpaid our paraprofessional staff.

Dr. Andy Roark:
Mm-hmm. I agree. Yeah.

Stephanie Goss:
And so when we talk about the paraprofessional staff, I feel like the conversation has to separate a little bit from the professional staff because I will agree with you 100% like the tracks for me, when I was in the beginning of my career, I had to keep moving up and up and up because I was a paraprofessional staff member who was living on my own and paying my bills and I had to keep making more money because we weren't talking about vast amounts of money, we weren't talking about salary level money, we were talking about hourly wage. So for me, that upward mobility meant changes in my life and my lifestyle and that was a need at that point in my life and allowed me to accomplish desires as well beyond basic needs. And when we talk about the professional staff, I absolutely agree with you and think that I was really happy when I got to the point in my career where I could have the choice to make a move sideways when it came to pay.
And my last two jobs actually, I have taken both when I moved to my last practice, and I'll be candid and share with everybody, when I came to Uncharted you and I had honest conversation because I was making significantly more in the practice when I tied everything up together, my base salary, bonuses, all of those things. And you and I had an honest conversation of this is where the company is, this is the salary schedule that I've set. And for me it was very much to your point about considering what are the things that I'm gaining that have nothing to do with money, the schedule flexibility, the culture, the ability to be doing something that I'm passionate about, all of those things that you spoke to. And it was the same for me in practice. I moved from a practice where I was working 60 hours a week to a practice where I could set my own schedule, where I was able to do Uncharted things as well as be in the practice where I had flexibility.
All of those things had worth and value to me. And so I'm absolutely a believer in that cultural component of it. And I think that it would be tone deaf to not speak to the fact that that freedom and flexibility comes significantly easier when we are professional. And I mean high salary level professionals. The difference between that and paraprofessional staff that is hourly pay wages. Because I think that that piece of the conversation to your point is important and people have the right to say “No, this is a need. I need to make this amount because my budget is set off this.” And professionals have that right as well. I could say as a new vet, that's the conversation that we have a lot of times when it comes to recruiting is like, “Look, if a new grad tells me that they're not going to take less than $150,000 as base salary, great more power to you. If that's what you need, you go, I can't give you that.”
To your point, that may be something that my practice can't do. And I think that when it comes to the wage scales, I love that they're asking this question because I think that the whole point of the pay scales is to have that transparency that you were talking about and to set some equity across the team. And the way that this manager is asking the question, they're talking about it being a good fit and taking the pay cut, and they're talking about the fact that at least they're looking at the fact that they have assistants now who have higher skills and more training and therefore should be making at the high end of their pay scale. And this is how we got to where we are at veterinary medicine because for years and years and years, we as untrained business professionals, managers and practice owners gave into, “Well, this person feels like they're a good fit and they're telling me that they make more money, so therefore I must pay them more to get them on the team and get them in the door.”
And this is what created the inequity in our industry when it comes to pay. And so I'm so proud of this writer who was just like, “Dude, I've already got the pay scales and they're asking great, great questions.” And I think that a lot of us are not even there. And so I love that you opened with that point that if you don't have scales starting with just the thought process that it shouldn't always mean that we increase and increase and increase I think is so great. And I love that.

Dr. Andy Roark:
Well, I appreciate you saying that. I agree with everything. I agree with everything you said. Yeah, I wanted to hit that point on pay scales is to say that's the downside of scales is there will be some person and you're like, “God, they're perfect, but they want more than our pay scale and-“

Stephanie Goss:
Then they're not perfect

Dr. Andy Roark:
And also it's not a pay scale. If you have a pay scale and you break it to get somebody that is unethical. That you've told everyone this is what the deal is and then you've kind of gone and made a deal that doesn't adhere to those guidelines with somebody else. That's not fair. So anyway, but I wanted to put that out just to say I felt like, and I don't know that a writer meant this, but I have seen this very simplistic logic of we have a pay scale. There's someone else who's come to interview, they were getting paid more than our pay scale, which means our pay scale must be raised across the board to match what this other person was receiving. And two things I want to point out to that is just to say, and again, I know most everyone who listens is going to immediately know this or pick up on this.
Just remember, salary and total compensation are not the same thing. And if someone comes to you and goes, “I made this amount of money,” and they're like, great, “Did you get a CE budget? Nope. Did you get vacation? Nope. Did you have a 401k? Did you get any sort of retirement matching? Did you get health insurance? Any of that?” Like “Nope, nope, nope, nope, nope.” Then you're comparing apples and oranges to say this is the salary. And so anyway, just remember to think in terms of total compensation for sure. And then the other thing is there are some simple things like geography where this person was working in downtown San Diego and now I live an hour and a half outside of San Diego and well, you are not going to make what you made in downtown San Diego because we can't charge what that clinic in downtown San Diego charged.
Those are some basic realities that most people would sort of understand, but also I just want to put them out and go, “Just remember that as we start to talk about this.” I think everybody should hold those numbers loosely. And at the same time, let me just say that sometimes there is this painful thing where someone says, “I want this job,” and you say, “I want you to have this job.” And they say, “I really do need to make this amount of money to make this work for me.” And you say, “I can't give you that amount of money.”
And man, everybody feels bad, but that's not an ethical failing at all. Sometimes it's just the way that it works and that's heartbreaking for everybody when it happens, but sometimes it just happens. And so I think that that is a good opening head space is what we need to look at this with clear eyes and just look at what's possible and set aside some preconceived notions about this person's never going to come here or they can't come here if we can't match what they currently make or we're obligated to give them what they currently make or we're somehow disrespecting them.
I think we have to set those things aside.

Stephanie Goss:
And I love that point and I think that the piece that I would add to it from a head space perspective in terms of trying to make a decision about potentially changing your pay scales. You said, “Do you have this one person who has come and is like, ‘I need to make this amount,' and you're bummed and you're looking at potentially changing your whole pay scale because of this one person.” I would say that the better head space would be to zoom out and say, “This manager asked the question, they're concerned that they're not attracting good applicants.” Are people going on a regular basis? Have you been trying to hire forever and you aren't getting applicants even in the door? Is this the first person who's walked in the door?
Or are you in a space where you do have long-term employees, you're not losing people because of pay and this one person who feels like a good fit has said that this doesn't fit for them. This is where the challenge with scales is because we're driven by people and we're driven by the emotion. This is where we're letting the emotions guide potentially the decision making process and where we have to zoom out and say, “We established the pay scales for a reason,” to your point. “And is there actually a motivation to change the pay scale or are we being swayed by the emotion of the situation because we like this person and we want to hire them?”

Dr. Andy Roark:
Yeah, I love that. I think if you're going to have pay scales, there's a couple things you have to own and one of them is you should not fall in love with the idea of the new employee. And if you have scales and you're like, “This is what I'm bound to.” This person comes in, they're a great fit, it is easy to fall head over heels and say, “Yes, this is the person for us. We've been waiting for this.” Don't do that because it's going to break your heart really badly when it doesn't work because they don't match into the scales that you have set and the way your business is set up. And that's going to hurt. The other thing is you can't take this personally, which means if this person says, “I'm sorry, I can't come here because my needs are not going to be met.” That's not a judgment on you as a person.
It's not a judgment of your business. It's like you have pay scales and you set them up this way and this is what you're able to do. You can't take it personally. And I think I see both of those things all the time. People fall in love with the hire that they're hoping to make and it breaks their heart when it doesn't happen. And when the person says, “I'm sorry, I can't do it for that,” they take it personally and they're like, “God, my business is a failure. No one wants to work here. I'm the worst. This practice is terrible. Everything is going down. Clearly we're going out of business very, very soon.”

Stephanie Goss:
Get out of new manager Stephanie's head because that was, I remember vividly, it's so funny that you just talked about that because I remember vividly as a new young manager, I was trying to hire a lead receptionist and I had an ad that I had worked really hard on and I found this candidate and she was amazing. And she came from outside veterinary medicine, but she had all of these relatable skills. She was personable, she was warm. I fell in love with her on the phone and then she came in for her interview and I was completely head over heels, like “Will you marry me?” So excited. And then I got to the point in my interview process at the time where I was like, “Tell me what you are looking at for salary.” And she told me a salary that was more than double what my pay scale was because she was coming from outside vet med and she had all these experiences and it was totally justified for the prior industry that she'd been in.
And there was zero correlation at the time to veterinary medicine. And I was crushed. And I was like, “Well, our salary range is here.” And she just looked at me and she was just like, “Oh,” and she was very kind and she was just like, “I am really sorry.” And she had great boundaries and she was like, “I'm really sorry.” She was just like, “That just is not where I need it to be.” And she's like, “I really liked you.” She didn't try and put pressure on, which was great and we parted ways, but you were in new manager Stephanie's head because I was like, “I totally failed. Nobody wants to come work for us. This is awful.” And once I got through all of that, the lesson that I learned the really, really hard way was there are limits, right? There is a structure.
And I knew going in into it, and that was the moment where probably 15 years ago where I started publishing in all of my ads, what our pay scale was and what the position paid because I never wanted to get to that point again where I was heartbroken and I had fallen in love with somebody and then here they are telling me that their expectation and my abilities are two wildly different planets and we're not even in the same solar system. I did not want to get to that space ever again. And so that's kind of an action step thing for me when it comes to hiring, but it seems so simple, but it's amazing to me how many of us do it to ourselves over and over and over again where we have this plan and we don't put it out there. And so I think that's really important, both the, not falling in love with it, but also putting up those boundaries and sticking to them.
And this would be a case where I think our writer said “We have a pay scale. We have a pay scale for a reason.” And if you immediately drop those boundaries because you've fallen in love with somebody, it's only going to hurt you and the rest of your team who is going to be frustrated when you have higher skilled people. We look at our peers who do this, you get somebody who is, you're desperate for a person and somebody comes in and they feel like a good culture fit and your head is telling you “Don't do this,” but your heart is like, “I want to help my people.” And so you do the thing and then one of your existing assistants finds out that the new person who has less skills is making $2 an hour or more. Yeah. And now your whole team is p off.

Dr. Andy Roark:
Exactly.

Stephanie Goss:
That's the exact reason why we create pay skills in the first place.

Dr. Andy Roark:
Yeah. Oh, you're exactly right. And I'll tell you this, the other emotional part of it too in head space for me very much is offering someone a job is putting yourself out there for judgment. Like asking someone on a date kind of. You know what I mean? Where you're like “Hey, I don't know if you'd be interested in this. I think you're kind of great.” And you're like, “Andy, that's ridiculous because one of them is clearly you putting yourself out there and the other one is just this company that you work for.” And I'm like, “I don't know.” Maybe it's just because I own, it's because I own the company that I work for, but you know what I mean? It sure is. There's a lot of identity tied up in that of I work so hard in a leadership role and I think most managers feel this way and a good manager feels pride in the place that they work and they should because they should be a big part of it.
And so they should, you do feel pride. And so when you're saying, “Hey, this is what I can do for you and we'd like to have you here,” there definitely is some fear of rejection there where someone goes, “No, I can't know, oh, I'm doing so much better at this other place.” You go, “Oh, maybe my practice is not as attractive as I thought. Or maybe we're not doing as good a job as I thought.” And I think a lot of people feel that pain a lot. So anyway, I think for me, all of this kind of comes back around to that head space of try not to fall in love with the idea, try not to take it personally. This is a relationship and it's kind of got to work for everybody. And so let's just start with that and kind of shake it out because I think as soon as we buy into the idea of salaries can never go down.
People will never, ever take less money than what they had before regardless of extenuating circumstances. And if they don't take the job, it's because you are not worthy. I think those are emotions that people actually have, even though they sound ridiculous when you say them out loud, I think you have to set those things aside. That's kind of my big thing. I think the last part of head space that I would say is there seems like there's a number of questions bundled together here.
And whenever I have a bunch of questions bundled together, it always feels like the Gordian knot, meaning it's the magical untiable knot and I'm like, ah, I can't figure this out. And the truth is usually what happens when I'm having feelings like this, I'm having questions like this, one of the healthiest things from a head space standpoint I can do is sit down and say, “What are the questions that I need answered in order to move forward?” And that's the mental process that I use. And so just sort of stepping back, what are the action steps? Well actually you know what, I'm going to put a pause here and say, how do I untangle this? How do we break this down into the action steps or into the questions that we need to get figured out? Let's take a break and then we'll come back and we'll do those as action steps.

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

Dr. Andy Roark:
All right, so let's come back here. So I just said the last thing for me with head space is whenever I have something like this that feels tangled, I need to break it apart. And the way I break it apart is to say “What questions do I need to have answered in order to move forward?” And so the questions here are, what is my current scale really? Which means do not get drawn into the dollar for dollar salary comparison. You need to look at your total compensation package and say, “What are we really doing?” Because it's easy. And I know a lot of practices that are like, “God, we can't pay people.” Well, other people pay them and I'll look. And I was like, “Man, you, you're offering health insurance and you are matching their retirement contributions and you have an EAP and you offer all these other services and you have a generous paid time off plan. No wonder you're not offering the salary that other peoples are.”
That's not right or wrong, it's just different. And beating yourself up because the salary offer you make while you've got these wonder, this nice collection of perks and supplemental things is that that's comparing apples and oranges. So what is your actual scale when we look at total compensation? Because that's what we want to compare to others. The next question for me is, is my pay scale competitive? And I don't know the fact that this one person comes and says, “I made more, I have less skill but I make more of this other place.” Maybe I'm not wrong. Maybe the other place was wildly overpaying this person and I'm sorry-

Stephanie Goss:
That's a thing that happens.

Dr. Andy Roark:
There's a 50% chance that if you go, “Either I'm low or she's high,” or they're both a little bit true, I don't know. And so is my pay scale actually competitive? If my pay scale is not competitive, can I afford to change it right now? And if it's not competitive and I can't afford to change it right now, how can I change it going forward? Meaning I might not be able to afford this person's salary now, or make, make the pay scale shift now. However, if I'm not competitive, I can make a plan to become competitive and maybe I can get this person to come along for the ride and maybe not, but I will remedy this problem and I'll be more competitive in hiring in the future if my pay scale is competitive and I say, “You know what? I'm doing what I can do. I feel like this is a competitive offer. I don't know that this person is going to find someone who will pay her or him what they were being paid at their last job.”
I'm not going to say that necessarily, but I am going to figure out how to present the fact that our scale is competitive and we'd really like to have them there. And I encourage you to shop around, obviously look and look and see what other places can do. This is what we can do and we would like to have you and I think you would be a wonderful fit here. How do I present that knowing that I'm not going to change my scales? And so those are the questions that I have. And if I can go through and answer each of those questions, bam, I'm golden.

Stephanie Goss:
Well, I thought kind of the same way because when I started reading the email, I thought they were going to go in the direction of, “Well, what if I wind up paying them more than I'm paying my existing team?” Which is one question, what is the potential risk factors there?

Dr. Andy Roark:
Yeah. Because the answer is don't do that.

Stephanie Goss:
Right.

Dr. Andy Roark:
The answer don't do that.

Stephanie Goss:
But then they-

Dr. Andy Roark:
You have a pay scale. You bought into it. Just so many bad things can happen.

Stephanie Goss:
But then they steered away from that in their email and were like, “That's not actually what I'm asking. What I'm asking is how do I know if I can afford to adjust my current pay scale?” And I think we talked from a head space perspective of do you need to adjust the pay scale? And I think you have to look at that. And I think your point about looking at is this a one off, is this an outlier or is this a consistent trend? And then I love your point about looking at is your scale competitive? Well, how do you know that? Well, you have to know what goes into your scale. To your point, it has to be about total compensation. You have to be able to compare apples to apples instead of apples to oranges. And you have to look at what other people are paying.
And that often is very, very hard to find in veterinary medicine because we are secretive AF. We don't share pay scales freely. We don't advertise as a whole and change is coming. There are lots of us who have been doing that for some time and now states are making it easier because states are requiring employers to provide pay information in their job ads, which I love. I that level of transparency. I think it's only going to benefit us in veterinary medicine. But being able to look at what is actually competitive and then looking at your own team. Are you losing people because of the pay or do you have really long-term satisfied employees? Is there a reason to make this change? And then to your point, the question that they actually asked, I love, and this is where I get super nerdy about how do you actually figure out if you can afford it? And I'm going to give a shameless plug for myself, which is really hard for me to do.

Dr. Andy Roark:
I know, do it, get up on the stage.

Stephanie Goss:
But also for our community. So I have a workshop in our community, in our knowledge library, which is where we house all of the materials from prior workshops and conferences that we've done. And I love this topic. This is a soapbox for me for sure. And I actually have a workshop that I've done about exactly this. How do you figure out how to afford it? And as part of that, I put together a spreadsheet for everybody. And so if you're a community member, you can access that in the library. And if you're not a community member, I'm just saying that's the kind of resources that we share in the community on a regular basis. But that's where I would start as a manager is it starts with a spreadsheet. And I know that not everybody loves spreadsheets as much as I do. In fact, I know Any Roark does not like spreadsheets.

Dr. Andy Roark:
It's not that I don't like them. I do like them, I don't love them like other people do.

Stephanie Goss:
But I have a color-coded spreadsheet for you guys for this.

Dr. Andy Roark:
I know I-

Stephanie Goss:
But I'm going to break it down.

Dr. Andy Roark:
I like a basic spreadsheet that's just-

Stephanie Goss:
I'm going to give the-

Dr. Andy Roark:
… plain numbers. It's just like a vanilla spreadsheet.

Stephanie Goss:
I'm going to give you the vanilla recipe right here. Okay? So the question is how do we actually know if we can afford it? And so what you have to know is what are you currently paying? What is your existing team cost you at their scale? Which means looking at their current wages and also their current average hours. And then you're looking at that as a percentage of your revenue and that's your pay, the percentage of your budget that makes up your paraprofessional wages. And now for most of us, the initial knee-jerk reaction is to say, “Well, my staff ratio is 25% or 19% or 28%,” whatever it is. And to go say, “Well, what does the industry tell me that that percent should be?” But that's the wrong question. The question we should be asking ourselves is where are we compared to where we have been before?
Which is are we trending up, are trending down compared to ourselves year over year? Because it doesn't do me any good. To your point about the pay scales and having, what did you say, Fort Jenkins, Texas. Having a practice in or outside of San Diego. Having a practice an hour and a half outside of downtown San Diego and a practice in the middle of downtown San Diego in the Gaslamp, just the rent alone on those two practices going to be wildly different. So there's going to be different expenses. It goes the same to staff. And so if I look at the industry trends, I do get some value by comparing myself to average practices. And AHA summarizes this really, really nicely. There's two resources that I would say AHA's benchmarks around compensation. And VH made us one as well, but the well managed practice study gives some really good industry benchmarks as well.
But it still doesn't do me, I don't think enough good to say, “Well, three to five doctor practices in a suburban area.” Well, what does that actually mean? Because the suburbs of San Diego could have wildly different pricings than the suburbs of Des Moines, Iowa. They're still suburbs, but those are two wildly different locations geographically. And so what I want to do is look at where am I trending as a practice? And so looking at that percent of gross revenue and then using that spreadsheet to play with the numbers. And so there's two ways that we affect change here. We can pay people more and not change the revenue and there's three pieces at play. There's our gross revenue, there's our cost to employ our team, and there's our other costs of running the business. So to impact those numbers, there are really three levers that we can pull.
We can increase our revenue, which would decrease the other two percentages because when we make more money and the costs stay the same, the percent goes down. We could increase the cost to our staff and not increase the revenue, which means that that percent is going to go up and then we have to cut costs elsewhere. Or we could do some sort of balancing of all of the things. There's a lot of things that we can do here, and this is where the spreadsheet comes into play. Because if you put in the simple numbers, you have your team, you list everybody and you just list them by their initials, put their salary, then in another column, put their average hours, get the total of your team's hours and the total salary that you're paying on them on average, and you can pull that straight out of your timecard software.
How many hours have people worked on average over the last quarter through the last three months? And then you look at that total wage and you look at it relative to your revenue, then you have the ability to say, “Well, if I gave everybody a $5 an hour raise,” and you can just plug that into the spreadsheet, Excel's going to do the work for you and tell you what that does to your percentage without changing your revenue. So then you have the ability to know, “Well, can I afford to do this without making any changes? Yes or no?” It becomes very black and white. You also have the ability to say, “Oh God, that number looks really, really high. If I give everybody $5 an hour raises, that's a,” I don't know. I'm just going to pick a number out of thin air, “that's $40,000.”
Well, that's a big scary number to a lot of us who own businesses, right? $40,000 is not chump change. So then I have the ability to go in there and play with it and say, “Well, if I cut some costs in other areas, what does that do to the percent? If I increase my revenue, if I make $10,000 more in that same quarter, how much does that suppress the percent?” It gives you the ability to play with those numbers. And that is by far the best way that I have ever found to do… You have to run projections and it has to do with the math. And not everybody loves math, but this is where you have to play and figure out how can I afford it? And most of us are afraid of this because we don't have the training, we don't have the knowledge.
I didn't know how to do any of this until I got got training and honestly, until I took business math class at the community college, I had no idea how to do any of this. And it made my life so much easier once I figured out how to do it. And I will tell you that I think that's where we got to in veterinary medicine is because a lot of us are either afraid of it don't know how, or a combination. And so we make those emotional decisions. Instead, we've fallen in love with the idea or we're like, “This is a good cultural fit,” or “My team is working so, so hard and we just need another person.” We make that gut emotional decision to say, “I'm sacrificing for the greater good. My team needs another body, so I'm going to pay this person $2 more than everybody else because it's going to make them happy.”
Well, guess what? In the long run it won't because someone will find out that the new person is making $2 an hour more than them and it will cause havoc in your staff. That's why we set up pay scales in the first place. And so I think that that's where we make the emotional decision because we don't know how to do that math. And that's a huge part of what made me so excited when we got this email. Because I was like, “Oh my gosh, this is a huge soapbox and I want to nerd for a minute, even though Andy's just going to sit there and give me the stare like ‘Really, you're talking about spreadsheets?'”

Dr. Andy Roark:
This is much spreadsheet time airtime as we've ever given in everything. There's never been –

Stephanie Goss:
Thank you for indulging me Andy Roark.

Dr. Andy Roark:
… this much airtime devoted to a spreadsheet.

Stephanie Goss:
I'm just saying.

Dr. Andy Roark:
No, it's good. It's good. It's just…

Stephanie Goss:
Andy's like “If you didn't understand any of what Stephanie just said in the last five minutes, you can go check out the financial workshops that her and Jen Galvin have done.”

Dr. Andy Roark:
There you go. We have financial workshops that cover exactly this. If you're like “Uh oh, tell me more. My heart purrs.” If you're just like, “I want more of this specific spreadsheet focus,” then we got you covered. We totally got you covered.

Stephanie Goss:
We do. We've got t-shirts.

Dr. Andy Roark:
You do have a t-shirt that says something like, “I have a spreadsheet for this, don't you?”

Stephanie Goss:
I do. I do. It was given to me by one of our community members who knows my love of spreadsheets.

Dr. Andy Roark:
Speaking of our community members, getting this back on the rails here. I was talking to one of our community members recently and he was talking about at his practice, they did some surveying of their staff, which I always think is great. And they're like, “What are the stresses of our staff?” It was a burnout type survey. And they were actually really surprised to come to understand that their staff was feeling a lot of financial strain. They live in a major metropolitan area and they didn't recognize how difficult it was for a lot of their staff to live in this area getting paid what they were paying. And of course they felt like they were doing a good job of trying to compensate their people. I think it's hard to get your head around what it really costs to live in a major urban area today.
And so anyway, but they saw that and when they saw that, they said, “This is not okay, we want to fix this.” And so they actually decided they were going to raise their prices and give 100% of that raise to the staff. And so they said to the staff, “We're going to raise prices and 100% of this goes to giving you guys cost of living raises.”
And then they sent an email to the clients and they said, “Just so you know, prices are going to be going up and here's why they're going to be going up.” And they explained that they needed to raise prices so their staff could have a living wage and not be financially strained. And so 100% of this price increase is going to the staff. And I said, “How did it go?” And he was like, “Oh, great. It went great. The clients seemed to understand. We didn't get any pushback at all. The staff were in board on implementing the raise in price because they knew it was important and they knew where it was going.” And I was just like, “That's a beautiful thing.” I just thought it's, again, thinking outside the box and being like, “Oh, we have a very specific problem. We're going to come up with a very specific solution to said problem. And here we go.” So anyway, there's definitely things that we can do.

Stephanie Goss:
I love it. And I think about that from my own behaviors as a consumer. And I think about, I lived in the Bay Area in California and they implemented healthcare for the restaurant industry and for restaurant workers, which is unheard of in the service industry that you would have healthcare coverage. And the business owners, restaurant owners were like, “How the hell are we going to afford this?” And so the conversation was, “We have to increase prices. There has to be something to offset this.” And so I know some of my favorite places who did exactly what you're talking about, and they just went to their clients and they're like, “Hey, this is why we're doing it. This is what we're doing with the money and we hope that you'll go along with us for the ride. And if you don't, we understand.” And I remember being impacted by that.
I would have paid it and I probably would have paid it and grumbled about it if they hadn't have been so forward. But once I got that, I remember seeing a notice when I went into one of my favorite restaurants and I was just like, “Okay, that totally makes sense.” Not only will I be happy to pay that extra amount, but I actually changed my behaviors to think about it and was like, “Here, let me tip.” Let me… I'm going to tip, I'm going to tip more. Which is I recognize not necessarily normal, but it was that emotional heart connection. And to your point, when we think about it and we put it in that context, it goes back to something you and I talk about all the time on the podcast, which is we can't be all things to all people. And we are going to have clients who would get that email and would be like, “I don't want to go there. I need a budget conscious vet practice.”
Totally understand. Totally understand. We might not be your people, and that's okay. It's the same as when the candidate that you're interviewing says, “Well, this is what I need to make for my budget,” to say “I totally get that. And I wish you the best of luck.” Because to your point earlier in the episode you talked about how do we have that conversation with them and explained to them like, “This is what I can offer you.” And for a lot of people that fills this with anxiety because we're just like, “How do I have to explain myself?” You don't have to explain yourself. You just say, “Thank you. I completely understand and I wish you the best of luck,” and move on because it's not going to be the right fit. You cannot be all things to all people, whether it's your team, whether it's your clients, stop. We've got to stop. And so I love that you use that example.

Dr. Andy Roark:
Yeah. Oh, good deal. All right. Well, that's what I got my friend. I don't think I have anything else.

Stephanie Goss:
Okay. I love this. Thank you for letting me talk about spreadsheets.

Dr. Andy Roark:
Oh, my pleasure. I'm so glad we got to do this.

Stephanie Goss:
You're not, but thank you for lying anyways. Take care everybody.

Dr. 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.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: compensation, culture, Practice ownership, raise, wages

Jun 14 2023

A Case For (and Against) Saturdays

This week on the podcast…

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

ABOUT OUR GUEST:

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

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

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

Uncharted Veterinary Podcast · UVP – 236 – A Case For (and Against) Saturdays

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

Submit your questions here: unchartedvet.com/mailbag


Episode Resources

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

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


Episode Transcript

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

Speaker 2:
And now, the Uncharted Podcast.

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

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

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

Leslie Mamalis:
It is, yes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark:
Easier said than done.

Leslie Mamalis:
Absolutely. Absolutely.

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

Leslie Mamalis:
It does.

Dr. Andy Roark:
Oh, man.

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

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

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

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

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

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

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: closing, culture, Practice ownership

Jun 07 2023

Are We Still Doing Non-Competes?

This week on the podcast…

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

Uncharted Veterinary Podcast · UVP – 235 – Are We Still Doing Non – Competes?

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

Submit your questions here: unchartedvet.com/mailbag


Upcoming Events

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

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

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

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


Episode Transcript

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

Speaker 2:
And now the Uncharted Podcast.

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

Stephanie Goss:
That time you weren't ready.

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

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

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

Stephanie Goss:
Oh man.

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

Stephanie Goss:
How's it going?

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

Stephanie Goss:
Wants to go out.

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

Stephanie Goss:
Yes.

Andrew Roark:
So yeah, he woke up-

Stephanie Goss:
Shockingly it is also raining in Washington.

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

Stephanie Goss:
Because it's always raining here.

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

Stephanie Goss:
Yeah.

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

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

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

Stephanie Goss:
Yes.

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

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

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

Stephanie Goss:
That's a good analogy.

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

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

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

Stephanie Goss:
Oh my gosh, yes.

Andrew Roark:
That's bonkers.

Stephanie Goss:
That's frightening.

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

Stephanie Goss:
Yes.

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

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

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

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

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

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

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

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

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

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

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

Stephanie Goss:
Okay.

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

Stephanie Goss:
Sure.

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

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

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

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

Andrew Roark:
Of course.

Stephanie Goss:
For sure.

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

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

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

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

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

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

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

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

Andrew Roark:
No, I agree.

Stephanie Goss:
Cool, cool.

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

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

Andrew Roark:
Thanks, everybody. Take care.

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

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: culture, doctor, hiring, management, Practice ownership

May 31 2023

When Non-Veterinarians Disagree with Veterinarians on Medicine

This week on the podcast…

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

Uncharted Veterinary Podcast · UVP – 234 – When Non – Veterinarians Disagree With Veterinarians On Medicine

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

Upcoming events: unchartedvet.com/upcoming-events/


Episode Transcript

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

Meg:
And now the Uncharted podcast.

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

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

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

Stephanie Goss:
This will be fun.

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

Stephanie Goss:
Sure.

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

Stephanie Goss:
Oh no.

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

Stephanie Goss:
Oh no.

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

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

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

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

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

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

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

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

Andy Roark:
Yeah.

Stephanie Goss:
That's a real good cause.

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

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

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

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

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

Stephanie Goss:
I'm taking off.

Andy Roark:
Yeah, I showed up tan lines-

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

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

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

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

Stephanie Goss:
Oh, it's fantastic.

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

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

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

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

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

Stephanie Goss:
Shut up.

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

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

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

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

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

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

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

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

Andy Roark:
Yeah, exactly.

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

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

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

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

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

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

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

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

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

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

Stephanie Goss:
I love it. Yeah.

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

Stephanie Goss:
Sure.

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

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

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

Stephanie Goss:
Great.

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

Stephanie Goss:
Of course.

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

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

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

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

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

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

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

Stephanie Goss:
Yeah, how can you do this.

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

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

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

Stephanie Goss:
No, I feel good about that.

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

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

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

Stephanie Goss:
Sure. Yeah.

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

Stephanie Goss:
They need a process.

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

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

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

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

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

Stephanie Goss:
That was a good one.

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

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

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

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

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: culture, doctor, management, Practice ownership, Vet Tech

May 08 2023

The Future of Financing Pet Healthcare

Uncharted Veterinary Podcast Episode 230 Cover Image

This week on the podcast…

Jonathan Wainberg joins Dr. Andy Roark to discuss how lending and insurance will play a role in pet owners affording veterinary care in the coming years. The discussion covers current trends in pet owner spending on wellness, best practices for communicating cost of care, and where the lending and pet insurance markets may be going in the coming years.

This episode is made possible ad-free by CareCredit credit card. For more information about helping pet owners in your practice pay for care or access pet insurance for their furry family members, check out the CareCredit website or the Pets Best Pet Insurance website, both Synchrony solutions.

Uncharted Veterinary Podcast · UVP – 230 – The Future Of Financing Pet Healthcare

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

Carecredit logo

This episode is made possible ad-free by CareCredit credit card. For more information about helping pet owners in your practice pay for care or access pet insurance for their furry family members, check out the CareCredit website or the Pets Best Pet Insurance website, both Synchrony solutions.

ABOUT OUR GUEST:

Jonathan Wainberg General Manager, Senior Vice President, Pet

Jonathan Wainberg brings over 15 years of financial services expertise, and a record of commercial ingenuity, market expansion and energetic leadership driving revenue growth to his role as CareCredit’s General Manager, Senior Vice President, Pet. In this newly established vertical, Jonathan will lead CareCredit’s expansion of the veterinarian credit business, pet insurance and additional market adjacencies.

Prior to this, Jonathan served as SVP, General Manager GAP. He joined Synchrony following a 15-year tenure with GE Capital, where he was the Senior Managing Director, Global Sales for Industrial Finance in London. He was a key member of the senior leadership team that reorganized and streamlined GE Capital. Jonathan developed the strategy and led the efforts that allowed GE to provide financing support to global customers in new markets, surpassing sales targets by more than 30%. With on-the-ground roles in the US, Europe and Asia, he’s managed teams around the world and delivered complex strategies in more than 50 countries.

Earlier, Jonathan joined GE Capital in Corporate Finance in New York, ultimately becoming Managing Director, responsible for the Eastern US, Canada and private equity firms, in 2012. As Managing Director, Jonathan originated, structured and negotiated leveraged loans and highly structured financings for leveraged buyouts, re-financings, expansions and restructurings of middle market and large cap retail companies. He was a top individual sales contributor from 2007-2010.

Jonathan has an MBA from Georgetown University and a BA in History with a concentration in Marketing from Concordia University in Montreal, Canada. He began his career in the executive training program at Macy’s in New York, where he also had various merchant/management roles.

Jonathan is a native of Canada, with a dual US-Canada citizenship. He has traveled to over 85 counties, enjoys entertaining, wine and playing with his energetic 2-year-old son.

While based in Costa Mesa, Jonathan currently resides in Bal Harbour, Florida with his wife and son, Jonathan will relocate to Southern California soon.

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

Submit it here: unchartedvet.com/mailbag


Episode Resources

Language That Works Infographic: https://www.carecredit.com/sites/pc/pdf/speak-pet-owner-healthier-pets.pdf

Uncharted upcoming events: unchartedvet.com/upcoming-events/


Episode Transcript

Andy Roark:

Welcome everybody to The Uncharted Veterinary Podcast. Guys, I am your host, Dr. Andy Roark. Guys, I got a special bonus episode for you today with the one and only Jonathan Wainberg. For those who don't know Jonathan or didn't hear him on a previous episode, he is Senior Vice President for Synchrony, working with teams at CareCredit and Pets Best, both Synchrony solutions. Guys, he's got his finger absolutely on the pulse of what is happening in finance, in vet medicine, and that's what we're going to be talking about today is keeping care affordable. What does the future look like for pet owners paying for vet medicine? Guys, this is a sprawling conversation to ask him about where he sees the industry going, where lending is going, things like that. He's got a lot of ideas. I found it really, really interesting. So guys, without further ado, let's get into this episode and this episode as a bonus is brought to you ad free by CareCredit.

Speaker 1:

And now, The Uncharted Podcast.

Andy Roark:

And we are back. It's me, Dr. Andy Roark and my friend Jonathan Wainberg. How are you?

Jonathan Wainberg:

I'm doing great. I'm just happy to have been invited back to one of your podcasts. I thought for sure on my first one, I tanked it, but listen, I'll take it.

Andy Roark:

The exact opposite. No, I appreciate you being here. For those who don't know, you are the Senior Vice President and General Manager of Pets at Synchrony, which encompasses CareCredit and Pets Best pet insurance. Yeah. So I wanted to have you on today to talk to you a little bit about the finances of this profession and the economy in general and where things are going from an economic standpoint in our profession. I think that you have an interesting perspective on this because of your involvement with both CareCredit and Pets Best. Can you go ahead and start at a high level of when you look at the economy at large and we're seeing rising inflation and things like that, where do you see our economy going and then how do you see the economy of veterinary medicine going forward?

Jonathan Wainberg:

Yeah, no, and thanks for having me. And this topic is so important now given everything that's going on in the economy, but just a headline news, we're living this day to day and so it is something that is important for us to discuss. And I think the last time you had me on, we talked about lifetime of care and all the costs associated with pet wellness. Listen, things have changed so much in the last six months and I think it's great that we're here to talk about that. Quite frankly, I think financing and financing solutions and flexible means of payment are going to become even more important as people do unfortunately struggle with some of the changes in the economy, whether it has to do with employment issues or interest rate issues with some of the other expenses going up, and we need to be prepared for that.

Andy Roark:

Yeah. Helping people pay for care is a problem that's not going to go away. If anything, it seems to me obvious that that's going to be a bigger and bigger part of what our jobs are going to be. I was thinking recently, one of the things that landed on me was emergency pyometra on the weekend, and this was a dog that was pretty healthy on Thursday and Friday and then they're at the vet clinic on Saturday with this emergency procedure. It's a $6,000 surgery to get it done, and I understand the economics of that and I understand why it costs what it costs.

At the same time as a pet owner, you look around and you go, “Man, I don't know a lot of people with six grand laying around that they're like, ‘This is not a problem.'” In the vein of sticker shock, I guess, is there messaging that you would like to see from a professional level? Should we be doing things to try to make people more aware of financial planning for pets? ‘Cause I think that's what you and I are ultimately going to end up talking about is, what is financial payment planning for pets, and then how do we encourage people who are pet owners who are generally just going about their lives, they have no idea what medicine costs. How do we get those guys into that headspace?

Jonathan Wainberg:

Yeah, no, I think… And this is the audience that we need to be talking to because they bear the brunt. This is the first line, right, your vet professionals and listening to this and the people that have to assess the health but then provide a treatment plan and show them. So a couple of things we've done, we've partnered with the AVMA on a study language of care, and I have it here in front of me, can't see it obviously on the podcast, but talks to best practices on things to say, and words do matter when you are communicating to pet parents, right. If we think about a term that we like to use in the industry preventative, well that doesn't resonate so much with our pet parents. Something like routine or checkup does much more for that.

And so it's little changes like that to think about, okay, how do we get people just getting more involved in first part compliance of care, wellness of care, because we know that just like humans, pets, if you provide them the standard care, are probably going to live a longer life and a healthier life and a happier life and not have those acute experiences perhaps as much. So try to reduce that. When you think about the financing element of it, we are there's language there as well where don't avoid the conversation, but talk about it in the right way. Address the elephant in the air in the room, right. People are so… The human animal bond relationship has grown so strong over the last few decades that people are willing to spend much more for the health of their family members or pet family members.

And so just preparing them upfront is integral. And so it starts when you… At the puppy stage, right. And you see some expenses, kind of jump up and talk to them about insurance, talk to them about CareCredit and tools that they should have. Because ultimately, as much as we like to plan, there are going to be surprises. Dogs and cats and [inaudible 00:06:34] companion animals, we don't know exactly what's going to happen and so we just got to make sure that we're prepared for the unexpected.

Andy Roark:

Yeah. I want you to expand on that a little bit. Talk to me about best practices inside the vet clinic that you see.

Jonathan Wainberg:

Yeah, I think it's having that open dialogue, right. And it's not an easy kind of conversation, but we need to shift the way the veterinarian teams communicate with their pet owners and perceptions about the value and the importance of veterinary care, right. And offering personalized recommendations. Use language vets reassuring about clients. 53% of pet owners want to hear recommendations from their vet owners and they don't want to be blindsided. We know that that came out of a study that we did from AVMA. They appreciate it. The veterinarian and the hospital managers and the vet techs, they are the most trusted resource for anything to do with your pet.

And so we need to work with our vet provider networks and the vet community to be able to have that open dialogue, talk about some of the costs that you can expect to spend. So just so you know, a first year pet ownership for a cat can range from about a $1,000 to $2,500. Dogs even more. Talk about those different courses of treatments and what people can expect and to some degree put together a plan of care when they're at that young age, or even if they then have some sort of acute need and a high ticket surprise, that's the ever time to say, “Well, let's make this just a onetime occurrence so that you're not caught off guard again.”

Andy Roark:

Yeah, that totally makes sense to me. So sign posting early on. I think that makes a lot of sense. I'm going to link to the lifetime of care study that you referenced. So you were on last time we talked about the $45,000 cat. And still I think that's such a powerful study just because you say that $45,000 cat and it blows people's minds and you can say, “Oh no, over the life of an animal, especially an animal that has some health problems, we can get up into these extremely high numbers.”

Jonathan Wainberg:

It's interesting, and it is. And I think in one of the interviews with one of the publications, we talked about a dog or $55,000. You say, “Lifetime care of a dog.” Someone says, “That's a very nice car.” And not to be crass about it, 'cause I take my dog over a $55,000 car any day of the week.

Andy Roark:

Of course.

Jonathan Wainberg:

She probably can't get me where I need to get to, but when you think about… She's a miniature poodle, I can't-

Andy Roark:

[inaudible 00:09:27] that small. Yeah, I get.

Jonathan Wainberg:

No, yeah, no, I don't think so. And pretty much now that she's 12, I'm spending more time carrying her than she is walk… But what I'd say is I think about that example, and it's an interesting example and I'd like your point of view on this. I go back to, well you have a $55,000 car, let's use that as an example. Well yeah, you got to provide that car with the right amount of maintenance. You don't just go to the shop or change the oil, you know, you don't change it… And then when you get an accident, you finally take care of it. No, you have to throughout that lifetime provide that care. And I know that that is something that our industry really tries to work with our patients on whatever it is, wellness and routine visits.

Well, in this study, and we didn't really get into it, but part of me is convinced that to some degree your pet within some standard deviation, it's going to cost the same amount. The question is, it's over how many years, right. So your pet is going to live longer if you give them that good care over the course of that life and they're going to be happier and healthier and a better companion and part of that family. And that that's something that really stuck out to me when I was looking deeper into the numbers and thinking about it with my own experience.

Andy Roark:

Yeah. I've gone back and forth on this. I really do think that we need to get these numbers out in front of people, right. For them to… How many of our pet owners have the realization of what it costs to have a pet, like, as the time that they're seeing a quote for an emergency procedure or something like that, and that's not how we want people to learn. And then I think part of it's, I'm not callous, I believe the human animal bond. And you see that the health benefits and the wellness benefits of having pets and things, we need to figure out ways to make this affordable so that people will continue to have pets and they're not a luxury. But it's always that balance.

Jonathan Wainberg:

You're absolutely right. Just having these numbers of the study in front of me, right. 38% of cat owners thought they were ready for a pet expense, but they weren't, right. And so if you think about that, that's 60% basically, 62% didn't, right. And that's a big, big number. And it's not dissimilar in the canine space, right, and so we got to keep banging this drum because the more we talk about it, the more people are going to be prepared and the more they'll be more proactive. Because the last thing you want to do is have to, you know, when you're dealing with the stress of an emergency of your family dog, your family cat, even in the equine space, the last thing you want to be thinking about is making a choice between cost or care, right. You want to be prepared upfront for that. And that's where being educated and educating your pet parent clients in the veterinary industry is so critical.

Andy Roark:

Yeah, I'm not surprised by the number as far as number of people who think that they're prepared and then they're not. I really think that there's a perception problem about veterinary care and what it costs. I think people have got anchored in their mind, you know, cost from 20 years ago and I go, man, there's been significant changes in where we are. So I see pet owners all the time that seem to be just caught by that. I guess that goes back to my earlier question when I talked about setting expectations and things. It's just something I think about. I think people don't get frustrated as much about things that they're not surprised by as they do when they're caught off guard, meaning what they expect to pay. If they expect to pay what it costs. They're generally okay, and it's a frustration and a challenge, but we hope to get the emotion is when they expect to pay much less than what it turns out to be.

And now they say, I'm wildly unprepared. And also I think all of us have had this problem of when pet owners feel like they don't have any options, they don't know how they're going to pay for this, suddenly it becomes a much more dire and emotional situation. And so I think that that's sort of where I was going earlier on when I was saying how do we normalize this? So let me circle back around to that and just sort of say, how do we normalize financial planning or even borrowing money for care as like, “Hey, this is a thing that happens.” I think a lot of people are still surprised that there are companies like CareCredit that exists for this purpose. How do we let people know about that ahead of time and make that sort of a more normal part of the conversation?

Jonathan Wainberg:

Yeah. We've tried to make it as easy as possible. We're accepting in about 85% of the vet practices in the US and so it's been around a long time CareCredit's been through all the cycles, it's something that is trusted and we have an incredible amount of network with millions of cardholders just in the veterinary space. I think… Listen, we believe that when someone gets a puppy or adopts a rescue, they should be presented with options of insurance, right for us Pets Best and as well as finance. And I think you're spot on about expectations and surprises and being scared off by stuff. So it's so important to talk about this upfront to get people to enroll. So it's a great tool. It works… And the great thing about CareCredit is it doesn't only work in the veterinarian channel, it works in other areas. So a lot of people actually have the CareCredit card in their pocket but may not know that it's accepted in that vet practice 'cause maybe they took it out for their kid's orthodontistry or if they had a laser surgery on their eyes, and that card has that inter-flexibility.

And the great thing about CareCredit is that unlike a lot of these buy now pay later products, it's something that you could reuse. It's a dedicated line of credit. We're a regulated bank, we have all the reserves, you know that we're here. We've been in the industry for 27 years. You know that you have that support. So by us having both Pets Best and CareCredit, you have different choices on how you can manage and prepare for those decisions. But ultimately, the thing I also want to point out, because I know we got a lot of vet professionals in your audience, I think that's our main target audience in this forum is it's also good business for the practice. You don't want to be taking on debts, your job and thank God it is your job and we're so lucky to have an industry where people are so passionate about caring for our animals and all the trials and tribulations that go with that.

But your job is not to be a bank. Your job is not to be a financing solution and you don't want to have receivables from clients. ‘Cause imagine how much harder that conversation is if they owe you money. How much harder it's for your cash flow and for your practices' financials if you're not getting that money. Whereas if CareCredit has it, you get it in that short amount of time. You don't have to damage or have those tough conversations with your clients on bad debts and stuff like that. We don't like to have those conversations either, but that is our job. We ultimately, if it comes to that, which we hope it isn't, but then we also have programs and practices to help people that perhaps could manage that in a more efficient way.

So I think that's also super important for people to think through as we go through a more challenging economic period. It's not just the owner or pet parent, it's also the practice. And all of you in the profession need to make sure that you're taken care of yourself as well. And this is one easy way to do it because I come from a family of doctors, I could say this, right. I've been blessed to have people in my family that are so passionate and it's in human health, but passionate about their clients. But you talk to them about the business part of that element and thankfully, to some degree, it's a secondary part because we need them focusing on the clinical part, and you shouldn't have that be a worry.

Andy Roark:

Well, the optics of vets shaking people down for debt is awful. I mean, it does not look good. It doesn't feel good in a world of social media where people can see your practice and your practice brand is out there and you want people to buy it and trust you. It looks awful and it feels awful for us to be like, “Hey, where's that money that you owe us?” You don't want any part of this. So that's a big part of it. The other part of it for me is staying in that optics vein and we look at social media and the way of the world these days.

I think if we're going to continue to be a trusted resource and to be able to stand out there and say, “Hey, we care about your pets and we value your pets.” We've got to continue to find ways to make care accessible and at least to give people options. So we say, “Hey, we're trying our best. We're giving people options on how they can make this possible.” We just don't want to have the image of people who say, “Yeah, we love your pets like family. You owe us this money and you better come up with cash in hand.” That's not who we are and none of us want it. And so I look a lot at that and say, “I don't want that in our future.”

Jonathan Wainberg:

No. And as that lifetime of care study showed and our a AVMA study that we partnered with the AVMA with, the veterinarian and the staff of the veterinarians are the most trusted resource and that relationship is everything. And you don't want anything coming in between that. Obviously we're fortunate to have those in the profession that are so dedicated to the space. But if there's something that can take away from any tension in that relationship, and we know that finance is not an easy conversation to have, but doing it early and then putting the… I wouldn't say the burden, right, 'cause it's our job, but at least removing that burden from you on that sort of financing and receivable side to a company that specializes in it makes sense. And it's almost, in my opinion, not worth the while to get into it. And there's just too much receivables in that space that it's just almost self-inflicted pain. I hate to say it.

Andy Roark:

Yeah, no, I get that. When you look into your crystal ball, Jonathan, you look ahead five years, what, what's patient care finance look like? What's different in five years than it is today? Are you predicting significant increases to the number of people who have pet insurance? Are there different financial products that we're not seeing yet or we're just starting to see, help me see the future of this?

Jonathan Wainberg:

Yeah, listen, I think pet insurance penetration is going to increase in the US. We're about 3% now in the US, but that's still very small. Is it going to get to the levels where in the UK it's 25% and in parts of the continent, even higher, European continent even higher? No, I don't think so because I think there's major cultural differences between the insurance experience, not necessarily pet insurance, but just general insurance experience in the US versus Europe and socialized medicine and stuff like that. And I know in Sweden there's certain pet kind of responsibilities that the government puts on as a pet owner that makes insurance something that's a lot stickier, making it claims automation. So you're making it quicker, making it easier for medical records to be uploaded. I think the other part of that is the app experience and the online experience very digitally native, which we know in our industry, and it is probably not where we stand out as being the most technologically advanced in our practice management systems and so on.

So working together with some of those partners to make that easier. I do also see, I don't think credit's going away. I think there's a place for both. And what I'm thinking is I think there's going to be a place where those two products work even more closely together, right. And how you can reduce the out-of-pocket experience in the short term while you're waiting to be reimbursed or even quicker reimbursement even at the time of care are things that, hey, how do we go and operationalize that and commercialize that as something that that's very important. So it's going to play a bigger role, and so these financial tools are going to continue to be prevalent.

Andy Roark:

Yeah. You got me thinking about what's possible. That's interesting. That's what I wanted. So I'm going to go ahead in the show notes. Guys, I'm going to link to the pet lifetime of care study that we referenced a couple of times. I'm going to link to the AVMA CareCredit collaboration, the Language of Care, which has got some really interesting things about setting expectations when talking to pet owners about finance and money, which I like a lot. Jonathan, for people who want more information, they're like, “Hey, I want to understand third party payments more. I want to understand Pets Best pet insurance, what resources do you like for them?

Jonathan Wainberg:

Of course, I'd say carecredit.com is a great place to start. You'll see there's a toggle that you can either choose as a patient or as a provider, right. And then there's sub sites on the industry, so obviously you click on the veterinarian space. You can also find a link there to Pets Best, but you go to petsbest.com directly also, to look more into insurance and how that works. What I can tell you is that people that have CareCredit and people that have Pets Best, we know for a fact that they have a better compliance of care for their pets than those that don't.

And so it is an important thing out there. We all have the same goal. We're all aligned here in A, making sure that your clients and your patients have that compliance of care and the best care and the best lifetime that they can, we want to help provide on the financial side that flexibility and that safety net that can enable them to do that. And so it all comes back to preparation, communication, and that relationship that you guys have is our strongest resource.

Andy Roark:

Yeah. No, that totally makes sense. Jonathan, thank you so much for being here, guys. I'll put links to the show notes for all these things down below. Take care of yourselves, everybody. We'll talk to you soon.

And that's it, guys. That's what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks to Jonathan for being here with us guys. Guys, I always enjoy these high level conversations, sort of predicting the future and looking at trends inside the industry. If you do, stick around. We're back every week. Come check out some more episodes. This is a Monday episode. I have another Uncharted Vet episode with the one and only practice management goddess Stephanie Goss coming out on Wednesday. I'd love to see you there. Take care everybody. Talk to you later. Bye.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: behavior, culture, fatigue, management

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