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fatigue

When a Great Tech Calls Out ALL. THE. TIME.

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are talking through a question that Stephanie admits she could have written in to the mailbag at one point in her management career. We had a manager write in and ask what to do about a great skilled, talented tech who just happens to call out ALL. THE. TIME? They are amazing for the patients and the team loves them when they are here. This management team just isn't sure how to take it from here. Let's get into this…

Uncharted Veterinary Podcast · UVP – 210 – When A Great Tech Calls Out ALL. THE. TIME.

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

Help Us Make More Great Podcasts in 2023!

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

New Workshop Series! Practice Owners and Managers, are you ready for some workshops to help kick-start 2023? Is this the year that you tackle creating a foundation of culture for your organization? Do you want to have a practice vision and values that do more than just look pretty on your wall? Do you want to have the right people in place on your team so that you can move forward in the same direction this year? Are you lost at where to start with leading meetings like this for your team? If the answer to any of these questions is YES, we've got you! The “Start Your Year Off Right” workshops can be taken together as a series or independently based on your practice needs.

Start The Year Off Right: Finding Values & Your North Star with Dr. Andy Roark

Start The Year Off Right: Loading the Bus with Stephanie Goss

Start The Year Off Right: Lead A Vision & Values Meeting with Dr. Andy Roark & Stephanie Goss

Upcoming events: unchartedvet.com/upcoming-events/


Episode Transcript

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This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Stephanie Goss:
Hey, everybody. I am Stephanie Goss, and this is another episode of the Uncharted Podcast. Andy and I had another great letter in the mailbag this week, and we are diving into it in this episode. We got a ask from a manager who is wondering, “What do I do about a great and really high skilled technician who just happens to call out all the time?” And I mean excessive amounts. I actually did the math during the episode and this technician has missed almost 50% of the weeks in a year. And so this manager is wondering, “What do I do? How do I deal with it?” Especially because there have been some conversations along the way, but maybe not as frequently as they should have happened. And I have a feeling that it's probably hit the point where the rest of the team is super frustrated about this situation. This was a fun one. Let's get into it.
And now the Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark, and Stephanie, you're never there, Goss. You're never there. So all right, I just got back from jury duty.

Stephanie Goss:
Oh, yeah?

Dr. Andy Roark:
I just got back from jury duty, and it was an experience. Have you ever had jury duty?

Stephanie Goss:
I have. I'm excited to hear how your… This was your first experience?

Dr. Andy Roark:
Oh yeah. Oh yeah. I don't know how they found me, but they did. I'm worried that… people were like, “Oh, once they get you, they keep calling you.” And it was the experience. I got summoned for jury duty, and I did not have time to go to jury duty. I talked to my brother who's a lawyer. I'm like, “I don't have time.” And he was like, “They don't care.”

Stephanie Goss:
Nope.

Dr. Andy Roark:
They could not care less.

Stephanie Goss:
They give zero figs.

Dr. Andy Roark:
Yes. And I did find that to be true, which is interesting. Because when was the last time that someone just looked at you in your face and was like, “I don't care what you want.” It was when my children were like two years old. Right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
When a two-year-old would look at you in your face and be like, “I don't care what your schedule is or what you have to do at work.”

Stephanie Goss:
I want it right now.

Dr. Andy Roark:
“You're going to do what I want.” And it was two-year-old and jury duty are the times in my adult life when someone looked at me and were like, “I don't…” And then they carried out the threat. They were like, “Watch how much I care.”

Stephanie Goss:
They're like, “Bam, you're on the jury.”

Dr. Andy Roark:
Yeah, no, it reminds me of when my daughter was two years old and her sock came off as we were driving. And she was like, “You need to stop the car and get my sock.” And I was like, “No, we have places to be.” And she's like, “I'm going to make you.” And then she just melted down until I got off the highway and got her sock. And I'm like, “That's jury duty.” They're like, “I can bend you to my will.” And so they did. They totally did. I went, and I got picked and put on a jury and I watched a case. I watched it because they made me, because they took my phone away. What do you call it? The bailiff?

Stephanie Goss:
Yes.

Dr. Andy Roark:
He takes your phone away from you. And not you can have this back at the breaks. He's like, you can have this back-

Stephanie Goss:
When you leave.

Dr. Andy Roark:
… when you are done. Done, done. So I sat there without my phone, like a caveman. And I watched these two people tell completely contradictory stories about what happened in a parking lot accident. I then I went and [inaudible 00:03:40] people.

Stephanie Goss:
But you lucked out in a way, because it had a relatively short trial.

Dr. Andy Roark:
Oh yeah. It was great. It was a half day. I got the experience of being on a jury in a half day, and then they let me go for the week. And I was like, “No, that was definitely it.” That was the best thing, was I go to-

Stephanie Goss:
Best possible scenario.

Dr. Andy Roark:
I got to go sit in a little jury room, I got to sit in a jury box. I got to see-

Stephanie Goss:
The whole nine yards.

Dr. Andy Roark:
… the whole courtroom thing. And then it was five hours, I was done. The longest part was sitting with the jury in the little back room.

Stephanie Goss:
For deliberation?

Dr. Andy Roark:
They don't let you leave until all 12 of you agree. And I don't know if you've ever tried to get 12 people to agree on anything, but it's a horrible system, I think. They're like, “Nope, you all have to agree.” And we went in, and I, of course, I couldn't not talk, because it's me. And so I was like, “Quick temperature check, who here thinks this person… who thinks they've proved negligence on this person?” Two people raised their hands and I'm like, “Dammit.” It's 10 people were like, “Let's be done.” And two people were like, “No, we're going to do this.” And so we asked the people, “Why do you feel this way?” And they're like, “I just feel this way.” And I'm like, “That's not…”

Stephanie Goss:
Not an answer.

Dr. Andy Roark:
Yeah, you cannot just be like, “I just feel this way,” and go against the 10 of the rest of us who are like… Okay. I was like, “But what does the evidence say?” And they're like, “You know, it's my gut evidence.” And I'm like, “That's not a thing. It's not a thing.” And basically we sat there for two hours and stared at them til they're like, “You know what? It's okay, it's fine.” Then we all left. That was justice that day. We stared at them until the got uncomfortable and just wanted to go home.

Stephanie Goss:
I think that we have listeners who would pay to be on a jury with you, just for the comedic entertainment value.

Dr. Andy Roark:
Oh, it's funny. When you're sitting in the jury room and they take your phones away and then they just leave you there until you can all agree. They come in there and be like, “Hey, it's time for a break.” And I'm like, “What does a break constitute, because we can't have phones, we can't leave the room?” It's like if I put you in a room that was like, “I need you to do this thing that involves talking to the people.” And then I came in, I was like, “Okay, you're on break now, but you can't leave the room and you're still here with the other people and you can't have your phone.” You would be like, “This isn't a break. This is me just doing the exact same thing I was doing minute ago.”

Stephanie Goss:
This is just dragging this out and prolonging it.

Dr. Andy Roark:
Yeah. I was like, “I don't want a break. I want to go home.”

Stephanie Goss:
Oh man.

Dr. Andy Roark:
So [inaudible 00:06:30], it was interesting. It was interesting. The funniest part was, it's a straight-up traffic accident in a parking lot. And one person was like… Both people said the other person was driving like a maniac and slammed in.

Stephanie Goss:
Of course.

Dr. Andy Roark:
“I was basically at a stop and the other person's a maniac.” And they both said that the accident happened in slightly different places, which fit with who ran in into who. Right?

Stephanie Goss:
Right.

Dr. Andy Roark:
If you believe it was this person, it probably happened over here, and if you believe it was that person, it's probably about 15 feet back this way. And there's no footage of it or anything. But one of the people was like, “You could see in the photo they showed us from the arrows that were drawn that this person was not at fault.” And I was like, “That person's lawyer drew that arrow. You can't…”

Stephanie Goss:
It's not actually evidence.

Dr. Andy Roark:
Yes. It's like, “That person's lawyer drew those arrows so that it would look like their client did not do the thing.”

Stephanie Goss:
Oh gosh.

Dr. Andy Roark:
But it was just funny that somebody was like, “If you look at these arrows, it's pretty clear who's at fault.” And I'm like, “You mean the arrows that their lawyer drew to protect their client and explain what happened? Those arrows?”

Stephanie Goss:
Oh, so funny. So funny.

Dr. Andy Roark:
So anyway, I was glad to be done.

Stephanie Goss:
We have a great letter from the mailbag for this week. I'm excited. This is going to be, I think, one of those ones where we go down a little bit of a culture rabbit hole. We got an email from someone asking, “What do I do with having an excellent technician with very skilled, good technical skills. They just happened to call out. And by call out, I mean excessively call out.” And so they were like, “I went back and looked, and this year this person called out over 30 times, sometimes for multiple days at a time for each instance.” And so they were like, “Look, the leadership team, floor lead, practice manager, multiple people have had conversations with them, and in the course of the conversations it's been productive and good. This person has opened up and they're having some mental health challenges.”
And so they were like, “Look, we are in a good place. We have resources. We've got an EAP. We've got a mental health coaching platform that we use. We've got therapy, psychiatry through our health benefits. This person has a lot of resources and they're using them. And the result is still that this person is out a lot, and it's a small hospital.” And so this manager was like, “We're a really small team, we only have four technicians.” And I say only, and lots of hospitals are sitting here going, “I don't even have one technician.”

Dr. Andy Roark:
Sure, yeah.

Stephanie Goss:
“Don't talk to me about being small team.” But they've got three doctors and four technicians to rotate through all the days that they're open. And so they're like, “When anybody on the team, doesn't matter that it's just this one person, when anybody's gone, we're severely short staffed and it puts a significant amount of strain on us. We lose revenue because we can't operate at full capacity.”
And so they were just like, “It's a reoccurring problem. And so what do we do now that it doesn't seem to be changing and there is this pattern? Because every single time it happens, it puts strain on everybody because we're working shorthanded.” And this manager was like, “It's also at the point where it's affecting me on a personal level because I'm the one who has to deal with the schedule, I'm the one who has to rearrange everything at the last minute and try and make it work, and I feel taken advantage of.” And so they were like, “We've tried talking to them, we've tried reducing their work schedule, doing less hours. We reduce it down to the minimum possible to be able to keep their health insurance benefits and none of the things that we've tried are working.” And so they were just like, “How do I deal with this? Where do I go from here?”

Dr. Andy Roark:
How dos from Stephanie Goss? What magic wand do you have that's going to fix this?

Stephanie Goss:
Oh, this is one of those asks where it's like, “What's the magic wand?” There is no magic wand.

Dr. Andy Roark:
It can be a short episode. Make the call. That's it, make the call. Anyway, we'll unpack this. We'll unpack this.

Stephanie Goss:
Let's do it. Let's do it.

Dr. Andy Roark:
But the thing is, you know who this is. It's the story of this lady who finds the frozen snake, and she picks the snake up and she sticks it in her shirt. You don't know the story?

Stephanie Goss:
No.

Dr. Andy Roark:
Fine. So there's this lady, and she's walking home at night in the winter, and she finds a snake frozen solid. She picks the snake up and she puts it into her shirt. And by the time she gets home, it has warmed up to get sort of life back into it, and so it bites her.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And she dies. And as she's laying there dying, she says to the snake, “Why did you bite me?” And he says, “You knew I was a snake when you picked me up.” And that's the story. There's a Buddhist story that's the same story about the-

Stephanie Goss:
That's really funny.

Dr. Andy Roark:
… scorpion and the frog. And anyway, just basically the scorpion says to the frog, “I need to get across this river.” And the frog's like, “Okay.” And the frog swims halfway across the river with the scorpion on its back, and then the scorpion just stabs the frog and kills it.

Stephanie Goss:
Sure, and stings it.

Dr. Andy Roark:
The frog is like, “Why did you stab me?” He's like, “You knew I was a scorpion when you put me on your back.” And again, this person is not bad. It doesn't sound like they're a bad person. It sounds like they're probably really struggling. Everybody's fighting a battle we don't know anything about.

Stephanie Goss:
Yes.

Dr. Andy Roark:
At some point you know what this is and you know who this person is. So that's headspace for me, it's the biggest headspace thing [inaudible 00:12:53], for me is this. And I've seen this. I've wrestled with this so many times in my life, is the if this person would just blank problem, which is when you look at the person like this and you say, “But she's a great technician and everybody likes her, and she's funny, and she's positive. If she would just show up and do her job, she would be amazing.”
I was like, “If she would just not steal money from the cash register, she would be incredible. If she just didn't sell drugs out the back of the practice, she would be awesome.” And again, I'm conflating these things that are wildly more problematic, but you get the point. That's the hardest thing as a manager, is when you see someone who is great in so many ways, but they have this thing that they're doing that is toxic and they will not stop doing the toxic thing. And it tortures me because I desperately just want them to stop doing the toxic thing and this'll be great. I have struggled with these people in my career because I think, “Oh, if she would just stop doing this or she would just do that.” And it is so painful to come to the point of realization that she's not going to stop.

Stephanie Goss:
Well or maybe she can't. Right?

Dr. Andy Roark:
Or maybe she can't, absolutely. Yes, very fair.

Stephanie Goss:
And so I think here that is, for me, part of the headspace is acceptance. For me, that is almost the totality of headspace is acceptance. At some point we have to accept…

Dr. Andy Roark:
It seems that way, because they seem like they've done a really good job.

Stephanie Goss:
Yes. Yes.

Dr. Andy Roark:
It's like at some point it really stinks when people come to us and they're clearly Uncharted listeners or they're Uncharted members and they're in there with us and they do it. It sucks because they come to us and they're like, “I did all of these things.” And I'm like, “Oh, you did all the things. There's nothing left. You did them all.”

Stephanie Goss:
It's so funny you said that.

Dr. Andy Roark:
Congratulations, you're boned at this point because none of this has worked. That's so bad.

Stephanie Goss:
It's so funny that you said that, because in my first thought as I was reading it was… But let's zoom out for the people who maybe haven't, who have been in this position who haven't tried all of the things. Right?

Dr. Andy Roark:
Okay, all right.

Stephanie Goss:
Let's give kudos to this management team.

Dr. Andy Roark:
Absolutely.

Stephanie Goss:
Because they were like, “Let's start with the resources. Here's what we got.”

Dr. Andy Roark:
Totally.

Stephanie Goss:
They're doing the right things. They've got an EAP, an employee assistance program. They have got additional mental health support in a coaching app, which I love the sound of that. I would like to find out more about that. They've got access to therapy and psychiatry through their health benefits which they're providing to their team, so all of these things are great. And they've been super supportive, where this person is like, “Hey, I need to take time off.” “Okay, take care of yourself. We've got it. We'll figure it out.” So big kudos there. That's step number one.
Step number two was they were like, “Hey, culture is important to us. This person is highly skilled and they are a great cultural fit.” And so you know what you talk a lot about how do we evaluate employees and we need to look at fit and we need to look at skill.

Dr. Andy Roark:
True.

Stephanie Goss:
So these managers are like, “We looked at the fit and we looked at the skill. When she's here, she's an incredible fit and she's highly skilled. This is the kind of person that we want on our team. This is the kind of person that we want to retain.”

Dr. Andy Roark:
“When she's here” is the operative words.

Stephanie Goss:
Exactly. That's exactly it. So the head space, I think, and the challenge for this management team is we have to come to a place of acceptance. And so this is a little bit of when the same thing happens over and over again, at some point it's become your business model. And so that is the case here. It has become the business model. There was some information shared, which it sounds like this person is not always necessarily being truthful when they're calling out. There is some far farfetched stories. Because I could hallucinate a planet where if someone is having struggles, whether they're physical health or mental health or within their family or home environment or whatever, at some point I've been there where it feels embarrassing to say the same thing over and over again. And so I could totally hallucinate a place where this person is like, “I can't just say I'm having a hard day again. I've got to come up with a very good reason.”
And so it sounds like they ventured into that territory where some stories have been made up, there's been some crazy-ass farfetched things that have been thrown out there as to reasons why they can't. And as a result of that, the leadership team is feeling like, “Well, now we can't trust her,” which is quite unfortunate. Because they were like, “If they would just say, ‘I need a mental health day,' that's fine. That is something we can support.” But now we're in this position where we feel like we have to deal with a problem that they have created because they're not just telling the truth. I think that that is something that we can pick apart and talk about. But I think overall, the answer is acceptance.

Dr. Andy Roark:
Well, you know what part of all this is? This stuff always gets me. So you've got this practice, and they are doing all of the things, you know what I mean?

Stephanie Goss:
Yes.

Dr. Andy Roark:
They've got psychiatric support, they've the EAP going, they're working on flexible scheduling and shortening hours and doing everything. And I'm like, “Man, these guys are crushing it as far as supporting this employee.” And you know what the experience of the other employees is? If you went and asked them or were like, “Hey, what's it working here?” They wouldn't be like, “These guys are amazing.” They would be, “It kind of sucks because this person just doesn't show up and then we just have to deal with it, and it happens over, and over, and over again. And so what is my experience? My experience is being surprised to be shorthanded again and again and again. That's my experience.” And god that sounds awful, doesn't it?

Stephanie Goss:
Yes.

Dr. Andy Roark:
Tell me I'm off base, right?

Stephanie Goss:
No.

Dr. Andy Roark:
That's how I see it go out all the time, is like you're in the leadership role and you are pouring your heart and soul into this, and the rest of the team is not impressed. In fact, they're just irritated, because what they see is not all the support that you're pouring in. They're seeing their own position, which is, “We're shorthanded again, and again, and again.” And again, they don't know why and they shouldn't know why. Right?

Stephanie Goss:
Right. Right.

Dr. Andy Roark:
We don't share these types of information about why we do what we do. That's an HR no, no. So they don't have the information. And so try to put yourself in their shoes and how does this look to them? It doesn't look good. And it's one of those things where sometimes no good deed goes unpunished, where we do what we can for this employee and we work so hard, that we end up irritating the rest of our staff and now our generosity has backfired on us. I don't know that that's happening here, but again, when we talk about finding balance, that's a big part of it. We want to help this person, and we need to help the staff and make sure that they're taken care of, the rest of the staff.
And we need to take care of clients, which mean clients need to know that they're going to receive a certain standard of care when they come in, and all those sorts of things. It all has to balance out. If you have one person that just keeps tipping farther and farther back on the scale, at some point you go, “We've done everything we can to try and balance this, but we just can't go that far.” I think that's where we come to acceptance, is go, “We've done everything and it's still not going to work.”
I think that's a bitter pill to swallow, but I think sometimes we have to that swallow pill. But let's go ahead and get into headspace here, and talk about where they are from a general place. Because this is pretty far down the line. Let's talk about what they did and how they did it and what we think about that. Does that sound good?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
All right, sweet. We're going to have people who are going to struggle at different times in their lives.

Stephanie Goss:
Sure.

Dr. Andy Roark:
That was the thing I didn't understand when I was younger. But as someone who has had a wife go through breast cancer, and had different employees at different times wrestle with personal things, and these are people I care deeply about. I don't know man, I just didn't understand earlier in my life how hard life is sometimes, and how complicated it is, and how good people go through hard things.
And I also didn't understand earlier on how much it meant to me to be a good employer and a good supporter of my people, how much it meant to me to say, “Hey, I understand you're going through something hard. Take care of yourself and take care of your family, and we're going to help support you through this because we care about you.” That feels great. And that is something that has meant a lot to me. And so I put that forward in headspace and sort of say, “Know what your values are. Know what you care about. Know about the type of employer that you want to be.”
I was… to say, “This is a relationship, and I want you to treat it like a relationship.” And man, I don't want to be in a relationship with somebody who's going to cut me off the moment I don't do everything that suits them. Or, the moment I'm struggling with something they're like, “Sorry, we don't have time for your stuff,” and dump you. I don't want that. At the same time, I don't want to be in a relationship with someone who continues to take, and take, and take, and take, even if they don't mean to. At some point, it's kind of like it is some of those things that I've heard and read something different things about. People who struggle with family members who just continue to drain, and drain, and drain. You say, “This is my family member.” But at some point you've got to say, “I'm sorry, I'm putting boundaries up to protect myself, even though this is a hard decision.”
I think that there's some parallels as employers of saying, “I'm going to be here. I'm going to support you, but at some point I'm going to be a part of the healthy relationship and I'm going to have to do what I need to do to keep my own head above water,” you know?

Stephanie Goss:
Oh yeah, 100%. When you don't do anything to have balance and set boundaries, you are 100% creating the co-dependent relationship. They are taking, and taking, and taking. But by you not creating any boundaries and saying, “Okay, I'm giving grace and these are the rules that we need to play by,” you are equally responsible for creating that codependency. And so I think that's part of the acceptance for sure from a headspace perspective. It's like, “All right, this is where we're at,” and ownership of that.

Dr. Andy Roark:
Well, the lack of truthfulness about what's been going on, I think this is an interesting life lesson. And again, a lot of the stuff we talk about… I think the reason that people like what we talk about and how we look at things in Uncharted is we tend to keep things pretty darn simple. I try to frame them that way, and they are. The truth is, once someone catches you not being truthful or their perception is that what you're sharing is not honest, you're going to lose that trust. Right?

Stephanie Goss:
Yeah, yeah.

Dr. Andy Roark:
Trust is hard to build and easy to lose. And once you lose someone's trust, one, it's hard to get back. But number two, it affects how they treat you and the grace that they extend to you. And so when they say, “We found this person not being truthful about what had happened or given these very farfetched stories,” and things like that, I'm not going to say to these people, “Oh, you can't hold that against this person,” or, “Don't let that factor into your decision.” It does factor into your decisions.
And so I think really, the truth is in personal responsibility, just as an employer or employee, as an individual. I think one of my sayings is, “Integrity above all else.” And the truth is come clean and be honest. And once people question your integrity, it closes a lot of doors for you. And I would say that's another reason… If I sounded flippant at the very beginning, this is part of the reason why, is because it's really hard to go forward with somebody that you're trying to take care of with the knowledge that they have not been truthful and they may not be truthful in the future.
It's really hard to do that. If you're dealing with someone who's struggling and they're being upfront about how they're struggling… And again, that doesn't mean sharing everything. Right?

Stephanie Goss:
Right, yes.

Dr. Andy Roark:
We all have privacy and expectation of privacy. But if they're not misleading us in any intentional way, I'm much more likely to try to keep going with them and saying, “Everyone's acting in good faith.” But man, once people start being less than honest about what's going on with them, that really closes the doors in the number of ways that we can work with them, just because we never know what we're dealing with.

Stephanie Goss:
Yeah, yeah. No, I think that that is totally true. I think the last piece of headspace for me goes along with that. Because, for me, part of the headspace is wrapping my brain around my own acceptance, as a leader, of letting it get to the point that it's at. Again, we're only hearing one side of it, and we're just reading the email and interpreting. But they were like, “We're at the end of the year. I did a look back, this person has called out more than 30 times this year, and there's been multiple wild stories and we've caught them in lies.” My question is acceptance of, okay, I have to own that. Did I have the conversation with them the first time it happened? Did I have the conversation with them the second, third, 10th time that happened?
And acceptance of the fact that, okay, we've gone far enough down the road that now it's not an easy conversation of, “Hey, yesterday when you called out, this is what you said.” I'm going to use a common example, “Then you posted on social media, or you sent a text message to the rest of the team and said, ‘This is what I'm doing.' So I know full well that that wasn't what you needed. I just need you to know, you don't have to give me details. It's okay to just say, ‘I need to take a mental health day.' Or, ‘I can't talk about it, but I need to take a personal day off.' That's what they're there for. I don't need the details, but I do need you to be honest.” Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
So for me, part of it is acceptance of my own level of responsibility as a leader. I will tell you, again, this is an episode that there was a time in my career that I could have written this letter.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
And part of it, part of the very bitter part of the pill, was the fact that I was… Like you said, I wanted so badly to support that person and be there and be accepting, that the pendulum swung way too far in one direction. And then when the rest of the team was raising their hands and saying, “But what about us?” I was struggling because I was like, “But I was trying to do the right thing for this person.” And the reality is, yes, I was. I was trying to do the right thing for that person. I was trying to give them grace. I was trying to support them. I was trying to not look like the manager who's like, “Screw that. You called off for this second time, you're fired.”
Because there are managers like that in our industry, and I get that these leaders were trying to do the right thing in supporting their people. There has to be the balance. If they team is like, “Hey, we're constantly short-handed,” and you, as a leader, are saying, “I'm the one constantly having to readjust the schedule and now it's affecting my mental health,” that's part of the acceptance pill to say, “Hey, maybe the pendulum has swung too far and I need to get into a headspace about my ownership of that.” Because in the action steps, in having some of those hard conversations, it'll probably make it a lot easier to potentially have a better outcome if you can own some of that.

Dr. Andy Roark:
Yeah. The last headspace thing for me, which I think is actually probably the most interesting part of this whole quandary here, is the mental health card. And that's an interesting term, but I'm hearing this term more often, the mental health card. And so to me, it's interesting because this has been put forward as this person is having mental health struggles. And that's one of the things that's been put forward.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And I think a lot of leaders out there are struggling with employees that are… or team members, or coworkers, or fellow doctors who are not performing, not meeting expectations. And the justification is, “Well, I'm having mental health challenges.” What do you do about that, and how do you balance compassion and support for this person with the reality that we have to have expectations to get met? We can't have people just not show up for work again and again. It's not fair to the other team. It's not sustainable. It shakes our whole business. Or, the behaviors that are manifesting are not acceptable behaviors.
I understand that you're struggling, and I can be compassionate about that. At the same time, I still can't have you yelling at the staff when you get stressed. That can't happen. And so I think that's an interesting thing. I'm saying I think there's a big spectrum of this. There is 100% the this person has legitimate mental health struggles and are struggling to meet performance. How do we manage someone who's struggling to meet performance because of mental health challenges?
And then there's the far extreme where there is the one that says this person may have other reasons for not meeting performance, but they're saying it's a mental health struggle because they think that that's going to get them more leniency than if they just said-

Stephanie Goss:
Sure, it's a free pass.

Dr. Andy Roark:
… “I just didn't feel like coming in.” Exactly right. And you'd hate to think that anyone would do that, but it's a big world and I'm certain that there are some of that.
And so people say, “Well, how do you manage these things and navigate these things?” And so I think we'll talk about this in action steps. But I think the headspace is assume good intent, assume that everyone is doing their best, compassion first. And this is all about balance, which means I can believe that you're having mental health struggles and I can be compassionate and empathetic, and at the same time just know that my job is to balance the needs of the individual with the needs of the team and the needs of the clients. And so I can be empathetic and compassionate and still say, “I need to balance these things out. And we have to figure out how to make that happen.” And we'll talk about that when we get into action steps.

Stephanie Goss:
Yeah, I like it. Do we want to take a break and then dive into the action steps?

Dr. Andy Roark:
Yeah, let's do it.

Stephanie Goss:
Okay.
Hey, friends, I just want to jump in here for a quick second and say that I am super, super pumped about all of the awesome things that we have coming down the pipeline in 2023. Now, we haven't announced all of the surprises that we have coming for all of you, but there are lots of great things coming to kick off the year. If you haven't signed up for some of the workshops and events that are happening in the first quarter of 2023, you want to head your little self over to UncharteredVet.com/events, and check out what we've got coming.
If you are a member, all of the workshops are listed there. You can log into your account and sign up for free. If you are not a member, you should check out what's coming and consider a membership for 2023, because you could pay $99 per workshop, but you also could pay $6.99 and sign up for a whole year of registration as a member and then you get access, not only to all of the workshops that we do, but all of the amazing content that happens over in our workplace group and our community. It is so fun, it is lively. It is just jampacked with conversation from the community about what's going on in their practices, how to solve challenges, how to support each other. It is one of my favorite places to spend time. I would love to see you there.
If you need that address one more time, it's Unchartedvet.com/events. Now, back to the podcast.

Dr. Andy Roark:
Let's get in some action steps here.

Stephanie Goss:
Okay.

Dr. Andy Roark:
Okay, cool. I'm going to start with your favorite thing. Let's talk about what they did, because they did a lot really well. Let's talk about what they did, and let's walk all the way up to where they are. And so, one of the first things that we've got to do to be successful… And I deeply believe you have to learn this the hard way. Every policy that we have probably came from a mistake that we made in the past. And so it takes a while for people to get here.

Stephanie Goss:
Yes.

Dr. Andy Roark:
You're going to love this.

Stephanie Goss:
Are you going to say it?

Dr. Andy Roark:
But we need to have our handbook. What is our attendance policy? What is it?

Stephanie Goss:
What does your handbook say?

Dr. Andy Roark:
And what systems do we have to support people who are having mental health challenges? I know you love it.

Stephanie Goss:
I do. Can I just bask in that for one second?

Dr. Andy Roark:
Yes, just soak that in. You should have-

Stephanie Goss:
What does your handbook say? Okay, okay. I like it.

Dr. Andy Roark:
What does your handbook say? But that has to be it, right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
Hear me on this, this is how we make the balance happen, is we sit down, not in the moment, not when we're dealing somebody, not when it looks punitive. But we just sit down and say, “Okay, what is our calling out policy?” knowing that life happens and we want to be generous to people, and we want to be supportive of people. I'm not making some Alcatraz calling out policy where if we can't find you then you can be off for the day.

Stephanie Goss:
Right.

Dr. Andy Roark:
It's not that. But what is the policy here? Because these guys said she's called 30 times. I don't know what the policy is, but it's not 30. That's not where we want to be.

Stephanie Goss:
And I love that. Obviously, I love that you said, “What does the handbook say?” But also I think that that's a good use case to look at and say, “Okay, we feel like there should be some sort of attendance policy, and someone who's called out 30 times feels a little excessive.” Let's look at that. When we think about what is… Okay, if there's 52 weeks in a year and everybody gets vacation and you figure out what is your actual working… How many weeks in a year does your average team member work? It's probably somewhere between 40 and 48 for a lot of people. What does that look like? Look at your own policies and then figure out…
Okay, let's just look at that. What is half of that? What is 50%? When you look at that, even if you just take 52 weeks. I don't know what their vacation policies are, so if I take 52 weeks, half of that is 26. If this person has called out 30 times, that means that they've only been there half of the weeks in the year. That is wildly excessive to me. Clear-cut, no brainer. Anyone could look at that math and say, “This is excessive.” It doesn't feel subjective, it doesn't feel punitive, it just feels excessive. And so it's easy to say, “Okay, if this feels super excessive and we know we want some sort… what does the middle ground look like?” You know?

Dr. Andy Roark:
Yeah. There's this exercise I talk about every now and there called Rawls' veil of ignorance. Rawls' veil of ignorance is the idea that if you look at a system, if you didn't get to pick where you were in that system, would you think it was fair? And if the answer is yes, then it's fair. I've always aspired to that. If I was the CEO, would I think that this was a good, fair approach? And if I was the janitor, would I think that this was a good, fair approach? And if I was a doctor, would I think it was a good, fair approach? And if the answer is all the things is, “Yes, I would think it was fair,” then you're probably doing pretty good.
And so I like Rawls' veil of ignorance, especially in this regard, because my goal is to come up with something that works for me, as the business owner, it would work for me if I was one of the technicians on the floor trying to get the work done. Or, if I was the person who was having some challenges and had to call out, I'd be like, “Yep, the system seems fair.”

Stephanie Goss:
Sure.

Dr. Andy Roark:
And so when they sit to make these, I really like Rawls' veil of ignorance because I don't know if I'm going to be the boss, I don't know if I'm going to be the laborer, I don't know if I'm going to be the person who's calling out sick because I'm having a family emergency or nagging health problems for my kid, or whatever. I think that my goal in this would be to say, “I don't know which of those people I would be in this situation, but wherever it was, I would think it was fair.” That doesn't mean I'd be thrilled with it. That doesn't mean that it would solve all of my problems. But I would understand and say, “Yeah, I think this is fair.”
And so when we start talking about these things, I think that's what we talk about. Say, “What's fair to the person who is out? What's fair to the team that is expecting support and not getting it when the person's out? What's fair to me, as the person making the schedule and scheduling the staff? What's fair there?” I think laying that stuff down ahead of time, I think that that's really key. And that's your attendance policy. At what point do they have to start having to have doctor's notes? Where does that happen? What does that do? But we need to lay those things down.

Stephanie Goss:
Sure.

Dr. Andy Roark:
The other part is to say when we talk about mental health stuff, I'm not a therapist and you're not a therapist. I am not a mental health professional and that shouldn't be part of my business model, I don't expect to be. However, I do what people to have support when they need it. And so when I'm done setting my attendance policy, I'm going to look at my mental health support options and resources and lay those things in and say, “If people are struggling, if they're having mental health issues, this is how we're going to get them support.” That's not me making it up and pulling it out of my ear as we go along.
It's like, “No, this is what we have, and this is how we're going to support these people.” And basically what I want, ultimately, is for those two things to come together and to make a good support structure to say, “This is our attendance policy and these are the resources that we have.” The expectations are that you leverage these resources and still abide by this policy that was put in place with the idea that some people would go through hard times. You know?

Stephanie Goss:
Right. Yeah.

Dr. Andy Roark:
But you can still check those boxes. And when the team comes to me and says, “Hey, Andy, why is Stephanie not here all these times?” I can say, “Hey, she is following our protocols that we have laid down. She has met the requirements to be able to request this time off and do these things. We're supporting her. But I assure you, she is working by the same policies that you would have accessible and available to you if you were in her position.”
And bam, I'm not telling you what it is. I'm not going into resources, or what resources you're using, but I can look at you in the face and say, “She's using the same playbook that is open to you when you face these challenges.”

Stephanie Goss:
It's equitable. Yeah, yeah. I think that's so important. And I think that's the hard part, because… And I will tell you I have done this, I will own this 100%, where as manager, somebody has figured out another loophole. I say that with all the love. And then I'm, “I am going to take my flaming, raging sword of justice and I'm going to update the handbook, because screw this.”
And then it never goes well.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
Everybody can see it for what it is. And sometimes that's a good thing, right? Sometimes, from an HR perspective, I can't share information. I can also let the team know, without saying much, “Hey, here's the new policy I need everybody to be aware of.” You know? Right?

Dr. Andy Roark:
Yeah, yeah.

Stephanie Goss:
And sometimes that is a tool. That should not be the first tool that you reach for. It's really easy when we're frustrated or we're angry, which is reasonable given the circumstances, that it's easy to reach for that tool first, and it shouldn't be the one that we reach for first. But I love that idea of doing it when you're not… Not punitively, not in the moment. But looking at the policies, looking at the protocols, looking at the support systems, I love that, because then everybody knows what to expect.

Dr. Andy Roark:
Yeah. And I find that to be true. I talked about the mental health card, and people say, “Well, what do you do when this person can't perform?” And they're pointing to this and say… If we've set up our systems well, then ultimately they're going to get support. And at some point they're going to come to a place where you say, “Hey, you've used up all your away time without a doctor's note and this is where we are,” and they have access to resources and stuff like that. But at some point you have to say, “This is where we're coming down on this issue.”
I tell you what's a nightmare to do, is to say, “Hey, we don't have any policies, but I feel like you've been gone too much and now I'm going to force this issue.” You don't want to have that conversation. The point of laying in these protocols is to have built in systemic boundaries where you can say, “Hey, just so you know, we're coming up on this and we're going to need to figure out what to do about it. You need to be aware that this is what our policy says and where you are in the program.”

Stephanie Goss:
Yes, and I love that you said that, because, for me, that is a huge part of the action plan and acceptance here, is the fact that we're doing this now. We're doing this as a look back. This person has now missed 30 call-outs in a year… I'm assuming in a year period.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
But whatever period of time. 30 call-outs and now I'm looking at it. And so now I'm like it's not, “Hey, you're coming up on the end of the policy. We get two weeks in a year. You've used a week and a half. Just FYI, I just wanted you to be aware of it.” It's the afterwards. And so it sucks, because in a way, and again, I say this as the manager who has done this, so please, if you're listening, don't take offense to this, you've tied your own hands. Because now you're having to have the conversation way after you should have laid the groundwork and had that framework conversation. Or probably multiple framework conversations and said, “Hey, this is where we're to.”
Now you have no choice but for it to potentially come across as feeling punitive, because no matter what you do at this point, it's reactive, because you're coming at it from a place of, “This has already happened, and now I need this to change,” which is not the place you want to be able to come at it from. You want to be able to come at it, like you said, Andy, from that place of, “Hey, this is how far into it we are, just a heads-up, just an FYI.” Because you're laying that groundwork, because then the conversation becomes easier. “Hey, remember how we had that conversation that you had a week left. You've used up that week, and so we're at that point, I just want to check in. I want to know how you are. How are you feeling? Do you think this is going to be an ongoing problem? Do we need to come up with a new plan? Do we need to talk about FMLA?” What are all of those options? You're doing it ahead of time when you do it the way that you just said.

Dr. Andy Roark:
Well, this philosophy, this approach that we use at Uncharted, it comes from dealing with clients who are strapped for cash, so clients who come in who don't have money for procedures. Originally, I spent a lot of time working on this. Exam room communication's a passion of mine, it has been for a long, long time. I wrestled with this for years. I can't look at somebody and know what their financial status is. I don't know if you have money or not, and I don't want to guess. It makes me feel gross and to look at someone and go, “Do you think she can afford this?” I don't freaking know. I don't know.
If you say to me, “Oh, that's a lot of money.” I don't know if that's because you don't have the money or if you just are someone who is cheap and is like-

Stephanie Goss:
That's a lot of money.

Dr. Andy Roark:
… “I have the money but I don't want to spend it.” And again, I'm never going to know. The place that makes me happy, where I found comfort is to say, “I've built a system for dealing with clients that doesn't…” I don't care what you have. I'm not going to treat you differently based on how much money I think you have. I'm going to make a system where we bring people in, we do our physical examination, we walk them through the process, we articulate what we are doing, we are open and transparent about our prices, and ultimately we come down to a place where we're going to present estimates and say, “This is what we want to do, and this is how we want to go forward.” We may give people options, or whatever we're going to do. But we walk through.
And again, it's not based on how much money we think you have in your pocket. Everybody gets treated the same as far as how things are laid out and what communications we have. And then ultimately, I don't really care if you have the money or not, I just need you to be open about where you are, and I'm going to be open about where I am. We're going to have resources in place to help you. If you don't have that money, we're going to have payment options, we're going to have lending options, we're going to have whatever else, a way to walk you through this.
But what's not going to happen is you're going to come in and make some vague hints about not having the money to take care of your pet, and then I'm going to throw all the rules out the window and just do everything that I can for you, not paying any attention to my staff and what the practice needs. I'm not throwing all that stuff away. That can't happen. And I see a lot of people do that. And so it really bothered me for years and years, until finally we just drilled in and we're like, “This is how we do the exam room.” And that's it.
If you're interested in that, I've got a team training course called Exam Room Communication Toolkit. It's at DrAndyRoark.com, where I do staff training. But all that stuff is 17 tools, but they all come from this type of approach of being like, “This is how we talk to people, and we work everyone through the same system. And ultimately, if there's a money problem, it comes out and we work through it within healthy boundaries.” And so when we start talking about absenteeism, when we start talking about people having mental health challenges in the profession and practices, and again, it's something I've wrestled with.
I went through a period of significant burnout a couple of years ago. It really, really sucked. My practice was greatly supportive of me. They were wonderful, and I would want to give that to other people. And at the same time, I expect the practice to have healthy boundaries and to take care of itself and to take care of the other employees, and take care of the pets. And that means having some guidelines in place before we get here that say, “I want to be supportive of you, and at the same time, you have some obligations here as well.” Whether it's cash-strapped clients or whether it's employees that are having mental health struggles, I think that that's the healthiest, most compassionate approach for everybody. I really do.

Stephanie Goss:
Yeah. And I think we're kind of at that point where we have gone past the pre-work. We talked about action steps that we can do in the future, and things that we can do to set ourselves up better for success next time. And at the same time, with this current technician, I think it's time to sit down and have a conversation. I would do it from a place of compassion and a place of care, but I would just say, “Hey, I need to sit down and have a chat with you.” And then I would kind of just lay out, “Hey, okay, here's where we're at.” This is a potential to own some of it on your own, and I found that it softens the blow.
I like to use this as a tool. It doesn't fit right for everybody, but I would 100% say, “Hey, I wasn't on top of this and I didn't realize that we're at the 30 mark, 30 call-outs for the year. That's on me. And now that I recognize it, I need your help because I can't go into the new year with this happening because it doesn't work for the rest of the team. I want to support you.” And again, I want to recruit them into the conversation. And so the way I would probably approach it is to say, “I can see a couple of potential solutions here, but I want to talk through all of them with you because you might have some ideas that I might not have thought of that I want to have on the table. But we've got to address this, because we can't keep going the way we're going.”

Dr. Andy Roark:
I love that so much. I love it. I love it because you owned it. And the more accountability we can accept, the more open a conversation we're going to have. I just think that, “Hey, it's on me that we got to 30.” I love that so much. I think that's excellent. And another thing that I really love in the wording that you used there is it's very future facing. “This is where we are. We're going into 2023, let's talk about what we're going to do differently, or let's talk about what we need to do in the coming year because we need to make some adjustments. And I said it's on me that we got this far this year. We cannot do this again next year, just so you know.”
And so I love that. I love laying it down like that and keeping it positive, and keeping it future facing.

Stephanie Goss:
And I think the other thing too, is to acknowledge that they may be in a situation that they can't control. Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
And so it's okay to say, “We may be in a situation where you need to continue to have time off, and that's okay. And here's how we can support you.” It's okay to say to them, “We can support you in the capacity that you're a part-time on-call, or on-call team member.” That could be a potential solution. It doesn't have to be, “We're going to keep you full-time and keep scrambling at the last minute.” It is perfectly okay to take that off the table and to just call a spade a spade and say, “I can't continue to be in the position where we're having to change the schedule last minute and the rest of the team is working short-handed, because it's impacting me on a mental health perspective, it's impacting the team. Short-handedness, it impacts the clients. I need your help to figure out how I can support you and not continue to be in this situation, because I want to do both of those two things.”
It's okay to put some of the accountability and responsibility back on them, because regardless of what they're going through, mental health or not, it is an unrealistic expectation, for any employee to have, to expect that they can show up when they want. That's not how real life works. I think that for a lot of us, we get afraid to be the adult and put the boundaries in place because we're like… For me, it was always like, “I don't want them to not like me. I don't want to be the mean one.” Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
And the reality is, I can't run a business if my team isn't here. And so maybe the answer is I hire more staff, because if I know I'm going to be short-handed, maybe I need to hire more people. That falls on me, not on them. Maybe they need to go to part-time. Maybe they need to be the on-call employee. This is where, for me, it's about the brainstorming. Because I won't know what's possible until we lay all the cards on the table. For me, the best case scenario is for them to be active and engaged in that part of the conversation, and also recognizing that they may be in a place where that's not possible.
If they are really struggling mental health wise, or they are having a challenge, they may not be in a place to contribute to that. I want to create a safe space where they can say, “I don't know. I just know that I need flexibility.” “Okay, then here's what I can do to support that for you. If you need flexibility, here's what I can do to support that.”

Dr. Andy Roark:
Cool. I want to hammer on this right here as well and say, remember that this doesn't have to be one meeting. I really like your idea of going in… Because to me, I always feel there's pressure to go in and say, “Well, what can you do? Okay, then here's what we're going to do.” It's like, “I'm sorry, I'm not that smart. I'm not that fast.”

Stephanie Goss:
Yes. Mm-mm. Nope.

Dr. Andy Roark:
I need to gather information and then I need to go away and I need to think about it. I need to think about what they say they can do or what their needs are, and then I need to think about what my needs are and what that looks like, and then I can come back and say, “Hey, this is what we need to do next year.” But it doesn't have to be at one time. Don't be afraid to step away. The other thing is ultimately you can do information gathering, and you are going to need to clearly communicate what you need to this person. Because otherwise it's not fair to not tell them what the realities are. And so you don't have to do that today, but you need to say, “Hey, we're at 30 days, that's on me. We got to do things differently. Let's talk about what you're looking at. Let's talk about what would be realistic expectations for next year. Let's talk about how we're going to move forward. I just need to hear where your heads at and what you think you could do to help me meet these needs.”
If this person needs to go part-time, then you go part-time. They might not like that, and I might not like that, but continuing to do the same thing again and again, and expecting a different outcome is the definition of insanity.

Stephanie Goss:
Yes.

Dr. Andy Roark:
If you just keep going and go, “I don't know, she just keeps up not showing up. I don't know what to do about it,” I think, “Well at some point it's not a surprise anymore, it's your business model.” And so anyway, I think that at some point, we have to say, “Look, this is what I need.” And you have to say what you mean, and you have to mean what you say. At the very beginning I said, “I see where this is going.” We can do all the things that we said, and ultimately this person… We can't make this person show up for work.

Stephanie Goss:
Nope.

Dr. Andy Roark:
Like I said, we can do all the systems in place and everything like that, and we can't make the person show up for work. There are ramifications of this person not showing up for work. It is going to cause you problems to have someone who no-shows again, and again, and again. It's going to cause you real problems to have someone who no-shows again and again, and there don't seem to be any repercussions for that person. That's going to have fallout, and you need to be honest about it, and you need to use what… You've already seen, I'm sure, to forecast what that looks like. And then, my friends, you're going to pick your poison at some point.
You've got three options. You can end this now, you can keep it going as it is and accept the fallout from this behavior continuing, which I would not recommend, or you can try to modify expectations and come to an agreement, knowing that if that agreement does not work, you're going to move to termination. And I think honestly, that's probably where I'd be, is I'd get real honest with this person. I would figure out what I really need. I would think about what a fair attendance policy looks like that accounts for people who have unexpected illnesses or sicknesses or mental health challenges, but it's still fair to them and to the rest of the team, and to me, as the practice owner.
I would put those things in place and say, “Look, this is where we are and this is where we're going, and this is what it's going to look like when we get close to running out of these days, and this is what it's going to look like when we hit those days. And this is what it's going to look like when we go past those days.”

Stephanie Goss:
Yeah. I love that so much. And I will say that for me, like I said, I was this manager at a point in my career, and I wasn't sure of where to start. And if you're like, “What would that even look like?” My suggestion would be even if you're a small business who doesn't… to whom FMLA isn't applicable, I would look at the Family Medical Leave Act. I would look at the standards there and say, “Okay, if I was a business of this size, this is what would be legally be required of me.” That's what FMLA says, is that when I have over a certain number of employees, these are the things that I have to provide for them in terms of leave.
And for a lot of businesses, they choose to have all of the leaves fall under that similar umbrella. There are other specific leaves of absence we have to be able to provide our employees, military service, domestic violence protection, et cetera. But most people look at it under that FMLA umbrella and say, “Okay, if someone was going to take a leave of absence for a physical health thing, I'm going to apply mental health the same way.” I looked at those guidelines and said, “Okay, this is what would be required of me. Could I make this work? Could I not? What pieces of it don't work for me as a small business?” If this really a small practice and their techs… their ability to lean into other support members is significant different in a practice that has four technicians versus a practice that has 100 plus employees and you have a bigger pool to draw from.
And so that's why FMLA is not applicable to everybody. But I would use that as the starting point. And for me it was like, “Okay, I can't give 12 weeks, but I could find a happy medium between what we currently have and 12 weeks.” To say, “This is what we could do.” Maybe it's some combination of intermittent. Looking at those kind of things and using it as a baseline to figure out where do I go from here, that would be my best suggestion.

Dr. Andy Roark:
Yeah. I completely agree. Yeah, I think that's it. I think that's kind of what I got. I hope that's helpful, as far as just thinking about. I hope he doesn't feel like we're beating up on our writers.

Stephanie Goss:
I hope so.

Dr. Andy Roark:
It's like it's one of those things where when you play the game really, really well, and then you're still like, “And the person still doesn't respond.” I go, “You've done everything right. The problem is, I'm sorry, I don't have a magical next thing for you to do.”

Stephanie Goss:
There's not a magic wand.

Dr. Andy Roark:
I think you know exactly what you're looking at, exactly who this is and exactly how they're behaving and what the pattern is. None of this is a surprise. I think you're at the place where there's nothing else to do but make the call, and the call is either, “I'm not doing this any more,” or the call is, “I'm going to put up with this,” or the call is, “I'm going to go to them and say, ‘This is the cahnge that I'm going to require to go forward. And if this change doesn't happen, then we cannot continue on together.'” I think those are your three options. I think I would go for number three.

Stephanie Goss:
Yeah, me too. Have a good week, everybody.

Dr. Andy Roark:
Yeah, everybody. Take care of yourselves. We'll see you later on.

Stephanie Goss:
Well, that's wrap on another episode of the podcast. This was so fun. Andy and I always enjoy spending part of our week with you all. We hope you enjoyed it. If you did, and you have an issue going on in your practice, or a question that you would love to hear us answer, or if there is something that you would like to hear us role play, talk through the details of what to say and how to say it on the podcast, please send us a message. You can find the mailbag at UnchartedVet.com/mailbag. Send us a message, whether you want to be anonymous or have a secret codename or not, send us your message and we would love to feature it on an upcoming podcast episode.
Take care, everybody. Have a great week.

Overwhelmed and Won’t Give Up! Part 2

Uncharted Podcast Episode 205 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are picking up where they left off last week! That's right, this is part 2 of our first cliffhanger episode (click here for Part 1). This week, we will dive into the action-step ideas for the challenge facing our repeat mailbag writer who was previously feeling squashed and stubborn. They are still at it and just as stubborn as ever, only this time, they are struggling with not letting client frustration over scheduling woes get them down. They are booked pretty far in advance and doing all the things they can to manage the schedule and clients are still really frustrated. They are voicing it to the team and it is starting to crop up in online reviews this doctor is asking for help in getting into a good headspace and not letting it get them or the team down. And also looking for help on how to communicate to clients that they have to wait and why it's okay to wait in some cases, without clients feeling brushed off. Let's get into the action…

Uncharted Veterinary Podcast · UVP – 205 – Overwhelmed And Won't Give Up – Part 2

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

Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag


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Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.


Upcoming Events

Pay Scales And Wage Transparency with Stephanie Goss

Recent law changes in multiple states and more coming down the pipe January 1, 2023 make pay scales and wage transparency an urgent matter for all veterinary practices to consider. 

Date: November 20

Time: 4-6 PM ET – 1-3 PM PT

The Secret Sauce to Optimizing Workflow with Senani Ratnayake, RVT

Back by popular demand! It's time to take a look at the workflows that aren't working and come up with a plan to move forward with a strategy that makes sense.

Date: November 30

Time: 5:30pm ET/2:30pm PT – 7:30pm ET/4:30pm PT

All Uncharted Veterinary Community Workshops are LIVE! You will be able to ask the instructor questions that help you address your practice’s unique problems. This will not be 2 hours of silent screen time. Gear up for interactive, fun learning!


Episode Transcript

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This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Hey, Stephanie Goss. You got a second to talk about Guardian Vets?

Stephanie Goss:
Yeah. What do you want to talk about?

Dr. Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing.

Stephanie Goss:
Yes.

Dr. Andy Roark:
And I'm sure you hear from these people as well, “Our caseload is blowing up and the doctors are busy and the phones just don't stop.”

Stephanie Goss:
They never stop. That is a true story.

Dr. Andy Roark:
I'm amazed by how few veterinarians know about Guardian Vets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and Guardian Vets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well, which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls and so we talk about it. We've talked about Guardian Vets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”

Dr. Andy Roark:
Guys, if you're not familiar with Guardian Vets, if you think that you could use some help on the phones or up the front desk, check them out. It's guardianvets.com. And if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardiansvets.com.

Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted podcast. In fact, this is Part 2. This is the second part of last week's episode where we started talking about feeling overwhelmed, but not wanting to give up. We tackled head space last week, so if you missed the episode, go back and listen to number 204, so you can hear what Andy and I had to say about how do we handle feeling overwhelmed about a certain issue in practice, but not wanting to give up on it.
This is a repeat writer from Squashed But Stubborn and we really appreciated their question about how do we manage it when our clients are frustrated that we can't get them in. And they're letting us know and we are doing everything we can to help them out, but it's still not fast enough for them. And now, maybe some of them are communicating it to the staff, but also leaving online reviews and it is hard to not let that get to you. So, Andy and I spent last week talking about head space and this week, we're going to dive into some of the action steps for how do we handle it when we feel overwhelmed. Let's get into this, shall we?

Speaker 3:
And now, the Uncharted podcast

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie “Taking You to the Streets” Goss. That's right. We're taking it to the streets. That's right. It's taking it to the streets because this is an all-action episode.

Stephanie Goss:
Yeah.

Dr. Andy Roark:
If Arnold Schwarzenegger made a veterinary business podcast, it would be this podcast. It would be this podcast.

Stephanie Goss:
I can't. I can't.

Dr. Andy Roark:
We managed the practices in an aggressive way.

Stephanie Goss:
I can't.

Dr. Andy Roark:
You will set boundaries for yourself. Get ready, crash cart. All right. I could have ended this thing. This is the best thing that has happened to this podcast.

Stephanie Goss:
Oh, God.

Dr. Andy Roark:
I know. That's if Arnold was slightly German.

Stephanie Goss:
Right?

Dr. Andy Roark:
That was. And much, much smaller.

Stephanie Goss:
Much, much shorter.

Dr. Andy Roark:
Much shorter, yeah.

Stephanie Goss:
Much less muscles.

Dr. Andy Roark:
Less impressive, yeah. He's like Mr. Universe.

Stephanie Goss:
I mean, it is almost Halloween.

Dr. Andy Roark:
I'm like Mr. Corner.

Stephanie Goss:
That could be a good… that could be a Halloween costume for you.

Dr. Andy Roark:
Oh, and I would… I mean, what do I need to do? Take my shirt off. That's it. Done.

Stephanie Goss:
Andy Arnold.

Dr. Andy Roark:
Yeah. It's like-

Stephanie Goss:
Same thing.

Dr. Andy Roark:
Same thing. Oh, my God, I thought you were him. Yeah, I get that a lot.

Stephanie Goss:
Oh, my gosh. If you're tuning in, you're like, “What are these two going on about today?” We're back. This is going to be totally different for us. This is Part 2, our last week's episode. We got to the end of head space and said, “You know what? Rather than give you guys marathon episode, we are going to break this into two.” And we are going to tackle the action steps next week because there's some really good ones and we want to dive into that. Andy, do you want to give a recap of what we started off with last week in case anybody missed the episode?

Dr. Andy Roark:
Yeah. Yeah, I do. So, let's go ahead and talk about the… we got a letter from the mailbag. And we have a veterinary practice owner who is trying not to burn out. Yes, she is overwhelmed with cases. She has lost… I'm saying she. I don't know if it's a she. It's just a guess. She's lost half of her technician staff in the last year and two and a half doctors this year. Only, it's two and a half because one of the people retired and has come back.
She can't get her regular clients in and she's really bothered because she can't get clients in who need to get seen. And they're saying, “Hey, I don't want to go to the emergency clinic.” And she's really hanging on. Seeing negative reviews is starting to bother her, even though she's really trying not to be bothered by this negative feedback from the clients who are frustrated that they can't get in. It's taken a toll and she does not want to give up. She wants to do the thing that she came to do and serve the purpose and take care of the pets. And at the same time, this has taken a toll on her. And she's like, “I don't know what else to do to keep the wheels on.”
And so, Stephanie and I talked last week and we talked a lot about… I talked about walking in the rain and I talked about the death spiral, which are different ways that we can get into this predicament. I talked about how common this is in Vet Medicine right now, how nobody can hire. It's very, very difficult to hire. There's a labor shortage. And so, a lot of us are having problem. We have unfilled job positions, things like that. A lot of us are working this way.
We talked a lot about sunk cost fallacy and how we get used to seeing a certain caseload and then our capacity to do that caseload falls off and we are unwilling to make adjustments with our new capacity. Things like that. We talked about responsibility that we have as far as pet owners deciding whether or not to take their pets to the emergency clinic and spoiler alert, it's not our responsibility. We have to be honest with them. We have to be honest about what we can do and it's their pet and we can't make them do anything. We talked about how it feels to have pet owners go to other practices and how maybe it should feel a lot less like a big deal.

Stephanie Goss:
It was a really great episode and if you missed it for some bizarre reason because…

Dr. Andy Roark:
So good.

Stephanie Goss:
… who wouldn't listen to us every week? If you missed it, you should go back and listen to the last episode because it was great. And we are going to pick up where we left off, which was we talked about head space. We talked about all of the things that Andy just recapped and we are about to dive into, “What do we actually do about this?” Because this is not a single-person problem. This is an industry-wide challenge to the point that you just brought up, Andy.
There is a labor shortage. Everybody is struggling with this. Everybody is struggling with feeling like they're a bit overwhelmed for a variety of different reasons. And there is this rebel fighting spirit of like, “I am not going to go down without a fight, so how do I actually fix this?”

Dr. Andy Roark:
Yeah, so the first step in this, for me, is to step away. The first thing is strategy. We need to disconnect ourself from working in the business and step back and work on the business because this is not as it's put forward, this is not a problem that's going to change. We're talking about we're a couple of technicians down, we're a couple of doctors down and it is hard to hire. There is no scenario where six people are going walk in…

Stephanie Goss:
Magically, yep.

Dr. Andy Roark:
… and take jobs next week and be ready to go. It is not going to happen. This is your new reality. And so, acceptance is the first part. And then strategy. All right? Guys, let's be honest with ourselves about who we are, what our capacity is, what our purpose is and what we're able to do. And separate ourselves from the pet owners in the exam room looking us in the eye asking for our help. That's working in the business. We're working on the business.
And so, it's about stepping back and saying, “All right. What can we do?” And so, my advice to you is to step back and say, “How many doctors do we have and how well are we able to support them with technicians? If we were opening up a brand new clinic, but again, setting aside our history, if we were opening up a brand new clinic, how many exam rooms would we use? And how many appointments would we see in our new clinic to service these doctors and keep them busy, but not burn them out?” And that is a painful exercise.
And I'm not saying you have to do exactly this, but I challenge you to unemotionally sit back and figure this out. And then, when we have these numbers and we say, “This is how I would do it and this is how we would staff,” I would say, “Great. Are our prices in line to do those things and to keep the doors open and to retain the staff and to make payroll, and things like that?” Because that is another thing where our pricing model was often built on us having a much bigger team and a much higher capacity and that changes. And I go, “Yep, that is an unfortunate thing.”
I hear from a lot of practice owners out there who are chewing their teeth and saying, “We can't raise prices.” And I say to them, “I'm sorry.” You, guys, if you've listened to my other podcast, Cone of Shame, you know that accessibility of care is a big deal for me and I want people to be able to get in and I do not want that to be a luxury item. And I promise you that I fight with this and I wrestle with this. At the same time, support staff salaries are going up. Inflation is a real thing.
Prices are getting more expensive. I mean I don't know about you, guys. Let's take gas out of this. Man, my grocery bill has gone steadily up and I buy the same thing. I'm a creature of habit. I buy the same thing. I swear I pay twice as much for it as I did a couple of years ago. It is valiant for us to want to fight these prices. At some point, it does no good for you to undervalue yourself and your staff and your staff leaves and goes to work somewhere else because they're able to pay a better rate. This is part of acceptance is let's be honest about the amount of work that we can do and then let's set prices to support our team in what we're doing.
And the good news is when people complain and they might, when they complain for us to say, “Hey, there's inflationary pressure. We are taking care of our staff. These are changes unfortunately that we need to make to stay in business.” To me, that is a very, very defensible position. I'm not saying that people will go, “Okay, that sounds great.” But I think at some level, it should not be unexpected for people and guys, it really doesn't matter because it is what's required for you to do your job.

Stephanie Goss:
And here's one of the things, this is, I see a lot of my peers and colleagues struggle with maths and let's be real. Maths are really hard, maybe second only to time zones being hard in the universe. But it is really a simple math equation. And walk with me here for a second, everybody, because if you take a step back and you look at your people and you say, “Okay, if we have one doctor now and we had four and we have two technicians and we had four, what can we do now?” I think that's a wonderful exercise and you do.
I love that you have to consider your pricing, Andy because that is the next piece. You have to think about, “Okay, if I'm now changing this patient load, what is my output going to be? And is that going to be enough to cover our butts and keep the lights on?” Okay? And then most of us look at it and say, “Okay, well, the only choice I have here is to drive up prices.” That's the first lever that a lot of us reach for. It's like, “Well, if I have less people, I'm just going to drive up the prices.”
And that's I think where the panic you're talking about, Andy, comes from our practice owners who are like, “But I can't raise the price from $20 to $40 for a thing because that's double. And owners will flip out and they'll never come back.” Okay. The thing that I think a lot of us have to keep in mind is that math is an equation. There is an equal sign in the middle and there is room on both sides to help balance this out. And so, too many of us look at it and say, “Well this is my only option.” But I will tell you if you increase a little bit on one side and you increase a little bit on the other side, you can still get to the equal in the middle, you guys.
And this is where so many of us look at it and panic and think, “This is the only button that I can push. I can only push more cases through the door or I could only push more money.” And really what this is about, the exercise for each one of us, because it is individual and every one of our clinics is going to be different. And if you do the work that you're talking about, Andy, if you step back and really work on the business instead of in it, you have to look at what is right for you and your team. And maybe the answer is your pricing model wasn't set up great and you should increase prices maybe even by more than double. That may be the answer in your clinic.
And also, there are plenty of clinics where the answer may be that, “Could you figure out a sustainable way to do a little bit more volume? Not a ton, not twice the caseload with half the people, but could we do a little bit more volume and keep our prices where they're at?” Maybe, right? But the answer is that there is room on both sides of this equation to balance things out. And I think that's a step that a lot of us, myself included, have missed because we stand there and panic and think the only option we have is to jack up our prices.

Dr. Andy Roark:
Yep. Yeah, I completely agree with that. Okay. I want to get into that in a second. Let me start here with, I want to talk for a second about capacity. And so, I talked about this in our last episode, but it's important enough I need to bring it back here and put it at the top. Okay. You, as an individual and your practice, but we're just talking about you as an individual. You, as an individual, you have a capacity.
There is a certain amount of work that you can do at a day in a healthy way. There's stress and there's distress and a healthy amount of stress is good. That means we're pushing ourselves, we're working hard. At some point, there is a capacity above which you are not stressed, you are distressed. Meaning, this sucks. You feel crappy at the end of the day.

Stephanie Goss:
And you go home crying.

Dr. Andy Roark:
And you don't look forward to coming back tomorrow. That's it. That's the line. You switch from, “Boy, I worked hard today. I'm kind of proud of myself,” to “That was sucky. And I'm going to be right back in it tomorrow and I feel crappy about it.” And if you are having those thoughts as you leave practice, you, my friend have switched. You've pushed past stress into distress. That's capacity.
Now, you can push past healthy capacity into distress and you can do that for a day or you may be able to do that for a week. You may be able to do it for a month or even three months or six months or maybe a year, the bill comes due and you need to know that. The other thing is, it is, I have never seen a scenario where the doctor is pushed to distress, but the team is happy.

Stephanie Goss:
Right. I was going to say.

Dr. Andy Roark:
If you're feeling that, you better believe your team is feeling something very similar and you might be motivated and dedicated and you might own this practice or you might not. You might just be like, “But I don't break. I don't give up.” Other people, that's your own weirdness that you came up with that, yeah, you can take that on for yourself if you want, but you are also dragging other people into that. And they may not feel the same way because they're healthy. They have a healthy perspective. Maybe that's why, but-

Stephanie Goss:
They have boundaries. The other thing that I think is really important here to call out and I'm going to call this out because I have been this leader. No matter how much of a poker face you think you have, no matter how well you think you hide your distress, my team doesn't know how worried I am. They know.

Dr. Andy Roark:
Yes, they do.

Stephanie Goss:
They know. And to your point, Andy, you might be able to hide it for a day, but if you are a leader and you are operating in the place of distress for any sustained amount of time, no matter how good you think your poker face is, your team knows.

Dr. Andy Roark:
Well, everybody has a bad day. But if you have a bad day after a bad day, after a bad day, after a bad day, that radiates out, right?

Stephanie Goss:
Yes.

Dr. Andy Roark:
Culture comes from the top and stressed out, that's a type of culture. We have all seen a stressed out culture. It comes from the top. And so, if you're the medical director, if you're the practice manager, if you're the practice owner and you are just stressed every day then that's radiating out. And so, I say this because it's important. The goal for you in practice should be to do good in the world, the most good in the world.
And if you work past your capacity and your staff quits and now, you're shorthanded, you are doing less good in the world over the long term than you would have been had you rationed it down to a reasonable capacity and kept your staff intact. And if you want to do good in the world and you see all the pets and you burn out in four years and you leave the profession, you're going to see way less pets and do way less good than you would have had you done less and stayed in the profession for 20 years. And not by a little bit like a couple extra pets like…

Stephanie Goss:
A lot.

Dr. Andy Roark:
… by orders of magnitude. And so, if you say, “I'm here for the pets. I'm here for the community,” what I would say to you is, “Are you here for the community in the year 2022, 2023 and 2024? Is that what you're saying? Or are you saying that I'm here in the community for the next 15 or 20 years until I retire?” And you need to make that choice. You need to make it now because my friend are running this race like a sprint and you're in a marathon.
And so, anyway, but we have to put that forward. And if you don't buy into that, if you say, “Nope. I don't believe in this idea of a capacity. I can just work hard forever and not break,” I can't help you.

Stephanie Goss:
Good luck.

Dr. Andy Roark:
I'm sorry I can't help you. I would say you are kidding yourself and it's time to get realistic about you being a human being and your own mortality. But once you do that then we can settle into the real work of saying, “How do I maximize my benefit to society, to pets, to people, to my community?” And also, “How do I balance my own enjoyment of this one trip that I get on this spinning globe?” Because you only get to go through the ride one time and this is your life right now and you better enjoy it because it's all you get.

Stephanie Goss:
Okay, so if we accept the fact that we have capacity and we need to figure out what that capacity is, then where do we go?

Dr. Andy Roark:
All right. Great. So, we've got a couple of things that, and they're all interconnected, which is why it's a little bit of a tricky fish. All right, so access Step No. 1 is efficiency. Well, first of all, you might look at your capacity and how you're priced and you go, “Yeah, that's it. We're going to make some adjustments to our current schedule.” Guys, let's actually start with that.
So, I'm going to start with scheduling. Scheduling is one of the first easiest things to help people out and I'm amazed at how many people do not feel good about their schedule or how they do scheduling. If you need a little bit of extra help in scheduling, we do have a course inside. It's the Knowledge Library in Uncharted, it's run by Dr. Saye Clement. It's actually really, really good. It's a way that Uncharted teaches scheduling. She does a fantastic job with it, laying it out. But if you really want help with scheduling, there's an Uncharted course that we have in the knowledge library and we should probably run that again before long.
Anyway, big things for me. You need to have a plan, right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
You need to have a plan and if every day you're just getting overwhelmed, you have a bad plan. If you are not doing schedule blocks, meaning, when we look at our schedule, we need to be intentional about what we're doing. And as we always say on this podcast, if you're surprised by something again and again and again, at some point, it's not a surprise, it's your business model. And it's amazing to me how many practices still fill their appointment slots up with wellness appointments and then act surprised sick pets have the audacity to show up on of them.

Stephanie Goss:
Thank you for saying that. Oh, my goodness. Thank you, thank you, thank you, thank you, thank you.

Dr. Andy Roark:
So, if your doctors are continuously running behind and they're stressed out, and I'll push you on this and say, if your doctors are, as a group, all staying late at night to write up charts, I would say you are pushing them past capacity, right?

Stephanie Goss:
Yes.

Dr. Andy Roark:
They need to have time to write up their records as they go along. And there's a fall off the medical quality when people put off records to the end of the day, saying, “Oh, we are keeping up because we're not doing this essential part of practicing medicine.” That's not keeping up, friends and it's bullshit. Pardon me. It's bullshit to run the doctors as hard as you can and say, “You get out of here at 6:00,” and then they're here until 8:30 because they're doing this thing that is essential for their job. That's not okay.

Stephanie Goss:
I think we have to stop for a second because there are so many practices, my own practice included, where the model was, “Let's keep the clients on time. Let's get the clients out on time. Let's get the team out on time.” And then the expectation is that the doctors are calling back clients and writing on medical records for anywhere from one to four hours after the rest of the team has gone home. And I agree with you, Andy, that is total. And it is something culturally that we absolutely have in our control to change.

Dr. Andy Roark:
Yeah. Now, I did say as a group, and I have to throw this caveat in because I 100% have worked in a practice where I am out on time and there is one doctor that's staying there until 9:00. And I would say that is a personal problem and I think a lot of doctors really struggle with that. If you are insisting on writing up three pages of medical records for every appointment that you see and not being efficient in your records and not looking at what other doctors are doing and not figuring out how to get out on time. That my friend, that is a personal problem that I think is often tied to a perfectionist personality and things like that.
And that is something that some people have to really struggle with and work with. And so, that is why I said, we need to look at the doctors as a group. But if the culture is everybody stays and writes up their records at the end of the day, I think that's a problem. And so what do we do? We need to be honest about keeping up and the first thing is to put some catch-up blocks. If you have a walk-in practice or a walk-in practice that takes appointments and also walk-ins, boy, if your doctors are always 30 minutes behind, by 3:00 PM you need to have a block. You need to stop taking appointments at 3:00 PM and have a block and say, “This is catch-up time.” And so, that's one of the first easiest things is be honest about how your doctors are running. And at some point, you can't take an appointment because they need to catch up.
The other thing is, again, if you have walk-ins, same day appointments. I'm a big believer in if people are going to walk in and your doctors are getting swamped, you need to have some appointments that are blocked off that cannot be filled until the day of the appointment.

Stephanie Goss:
And I have to say this because I see it every single day in the communities that I am a part of, including in Uncharted, where somebody asks the question still, we are how many years into this pandemic and the changes that we've had with our schedule. And somebody says, “But we have three sick pet blocks on the schedule for the day. And everyday, it's just not enough and it's not been enough for three years.” That is the problem.
You have to step back and look at that. Like you said, Andy, if you're asking the same question over and over again. Good, if you're surprised, it's your business model. And the reality is no practice, not even a single doctor practice most of the time, I would argue, and this is one that I would… well, this is a hill I will die on, can have three sick pet appointments in a day and not fill them. We are in a place where we all have clients coming out our ears and what used to work for us having two or three sick pet appointments per doctor doesn't work anymore. When's the last time you only saw three sick pets in a day?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
It's been years. Sometimes, we go through waves where there's not a lot of sick patients, but be honest with yourselves and your team. Sit back and ask yourself the question, “When's the last time we only saw three sick pets in a day?” And really, I think, I'm so glad that you brought it up because I think we need a radical overhaul of how a lot of us are approaching scheduling because we are doing it to ourselves.
We are letting ourselves be surprised over and over and over again and it has become our business model. And I see it and it drives me crazy because it goes back to what you said about in the head space piece, about we don't have to keep doing what we've always done and this is the prime example for me when it comes to scheduling. Well, but we are leaving two or three spaces. Ask your team that question. Ask your CSRs, “When's the last time we only had three call-ins in the morning for sick pets?”

Dr. Andy Roark:
Yeah, yeah. I completely agree. At some point, some of this probably starts with auditing. It's, “Take a moment and we're going to work on the business.” Look. Look objectively at what's actually coming in. Are you getting a ton of sick pets? Are you getting single sick pets that are really sick? Are you getting a ton of sick pets that are mildly sick? Are you getting sick pets that really could be, they could wait another day or two but they just they don't want to? Are you getting really sick pets that are getting turned away because mildly sick pets got those appointment slots first thing in the morning? All of those things can be adjusted.
I've come a long way on charging emergency fee as well and I still waffle back and forth. And what I'm going to say is it depends. It really depends on what you're looking at and how you're looking at it. There are downsides to charging an emergency fee to get in. Meaning, that some pet owners don't like it. If you are looking at a place where you have a certain number of sick pet slots a day and those are getting grabbed by people that could conceivably wait a little bit longer, they just don't want to, then it may be time to put an emergency fee on there that says, “Well, if you're going to come in as an emergency, you're going to pay more.”
And the idea of that, honestly, is not about making money, it's about making it a bit of a barrier so that people are incentivized to wait an extra day or two if appropriate, obviously. And we're going to have to teach our techs or our front desk on that.

Stephanie Goss:
And that's where you think about the human emergency room. That you go to the emergency room when it's truly emergency and there are lots of people who are like it's not “I don't want to wait.” Sometimes, it's “I don't feel like I could wait and I'm not sure.” And I think that that is medically acceptable. And there's also lots of people, and I hate to say this, but having kids, I've been that person where I'm like, “I can't wait another two weeks to get in. I will just pay the extra money to go.”
And I know full well I'm going to sit in the ER and so, I time it, so that I have the time to sit there with my kid. But when they've got an ear infection and I need to start meds now, not three days from now or four days from now, that's the price I'm willing to pay. And I think we have that model in human medicine. And let's be honest, it does not come without problems. It is part of why the emergency rooms are overwhelmed, both in human medicine and in animal medicine. And I recognize that and I'm not advocating for it because I don't think that is the only solution.
But I think your point, Andy, about there are always going to be clients, who are willing to pay no matter or do whatever, no matter the barriers you put up. And so, I think we have to acknowledge that and recognize that it's happening and also have a plan to help discourage the majority, so that we can help more people.

Dr. Andy Roark:
Yeah. And that's where the line in this. It's not about trying to punish people who have emergencies. It's really not. And so, I'm not like, “Charge more and more.” It needs to be enough ideally that it incentivizes people who we think that their pets can wait. It incentivizes them to just wait a couple of days and leave spots open for people who really need it. At some point, it's not about punishing people who have true emergencies.
The other thing is if you're at capacity and you say, “We cannot turn away sick pets. We just cannot do it and we're at capacity and these are coming in on top.” I would say, I think an emergency fee is absolutely warranted once you hit capacity. So, you might even have same day slots that can be filled, but once those same day slots are filled, if you still want to take emergency, you can. But that my friend is a bonafide emergency and is getting emergency fee. And I would figure out how to take that and give it back to the doctors or back to the staff because they're getting this extra stuff dumped on them. And while I'm trying my best to reduce that load, if I can't reduce it, I'm at least going to try to do something that is nice for those people.
And so, anyway, I'll give you a quick example. If you have doctors that are paid on production or pro-sal and you add an emergency fee, they're at least getting some extra compensation for taking that emergency over just another appointment that's being dropped on their plate. And that's just something to think about. In doing scheduling, we need to have a system for communicating from the back up to the front.
And so, if you're going to take walk-ins, one of the big things I see is the back is completely slammed. It is pandemonium and people are crying and the people up front are blissfully unaware. They know it's busy, but they don't see the chaos going on in the back. And so, they're taking walk-ins and sitting them down and things like that and the back gets super mad at the front. And the front is like, “What? We're doing our job. We have no idea.”
I really am a big fan, if this continues to be a problem where the back is getting angry at the front because the front keeps letting people come in, we need a communication system. And that can be, I've seen some light systems where people in the back can flip switches or hit a button. And there's a little green light that's front which means, “Hey, we're good if people walk in.” And there's yellow, which means, “Tell them that there's going to be a 30-plus minute wait.” And then there's red, which means, “We are not able to see anyone for the next three to five hours.”
And then at least the front desk knows if someone walks in, you can say, “We are not taking any more walk-ins. It's going to be at least a five-hour wait. We recommend you going somewhere else. We're not going to be able to see you today.” A lot of this stuff is clear communications and it's amazing how we suck it up and we don't tell pet owners. And again, if the pet owner is willing to pay the emergency fee and they're willing to wait five hours and it's not going to put us working past close, okay.
But it should at least be like a restaurant where you go into a restaurant and we've all walked into restaurants and the place is packed and they're like, “Oh, we might have open tables at 9:00 PM.” That's it. “We might be able to seat you at 9:00, but I can't even promise that.” And I go, “Well, I'm going somewhere else.” And then I leave, but at least I'm given that information. So, anyway, that's sort of back to front communication. Clear expectations, I think are the other part that I was just saying is we need to let clients know we are completely filled up. And if you want to be here, you're going to pay an emergency fee and you're probably going to wait four to five hours.

Stephanie Goss:
I love that and I think the other piece about communication, I was thinking while you were saying that, I think the other piece about communication is a lot of us are afraid. I have felt afraid to communicate outwardly to clients what is happening for fear that of I guess, of judgment of that they're going to think that things are falling apart. That we don't have our ish together. I've been there when you have gone from four doctors to one and it's like, “Do I tell them?” And the answer is yes.

Dr. Andy Roark:
Yes. The answer is yes.

Stephanie Goss:
If you are not communicating to them and you are not setting expectations, you are failing them. And a lot of times we make those decisions because we're afraid. Like, “Oh, but we're working on hiring other doctors. We're working on getting relief, so I'm just going to hold off on telling them.” It's all done with the best of intentions and I say that because I have been there. And at the same time, we are doing them a disservice when we are not communicating to them the expectation for reality.
And I have seen more and more clinics start to be open and honest about that and I think that there's ways that we can do that that are more successful than others. And I think a lot of us communicate from that place of panic and it can outwardly look a lot more chaotic or discombobulated, which is not what we want. So, I think it has to be strategic and smart. But look, if your reality is you were a four-doctor practice and you're now a one-doctor practice, you have to communicate that to your clients.
You are going to change your business model. You cannot go from seeing 50 patients in a day to seeing a one-doctor caseload and not have clients hacked off when you tell them, “It's three months from now before I can schedule you.” You have to take control of that situation and do some communicating. And so, I love your ideas, Andy, about communicating in the thick of it in the day between front versus back and also, with the clients as well.
And I've seen more of my peers start to have and share outwardly their local clinics and ERs have spreadsheets that they're using together to communicate, “Are they taking patients? Are they closed to patients? What's their wait time?” I've seen more of my GP colleagues share that kind of information outwardly on their Facebook pages, websites, whatever, for their clients to have access to it. Which helps them cut down on the volume because if clients can get that information themselves and see that there's a wait, it cuts down on the calls that the GP and the ER are both fielding, which is brilliant.
But also, being able to communicate that if within your own practice as well, but also the long-term piece of it. If this is not a short, if everybody is out with COVID, that's one thing. If you're closing temporarily because you've got a stomach bug going through a clinic, whatever, but when your reality is going to change for an extended period of time, it is your job to communicate that to your clients as well or we are failing them.

Dr. Andy Roark:
Yeah. You can be vulnerable, honest and a professional at the same time and you should. This falls right into our category of pick your poison. Do you want to not tell people what's going on or the realities of the situation because they might think less of you and deliver a crappy customer service performance because their expectation is that there's nothing going on and you should be functioning at full capacity? Or do you want to tell them this is our reality at the moment and thus, what you should expect in your visit and have them be disappointed that they're not going to get in, but also not be surprised?
Remember people don't get mad about what you give to them. They get mad about the difference in what they got and what they expected to get. And they're expecting to get what they've got in the past and they're going to be mad even though you do your absolute best. And I think that that is really important point.
I've got an article that just came out in today's Veterinary Business this month and I looked at it yesterday, I had completely forgotten what I have written. But I wrote about being in Charlottesville, Virginia with my wife and we were on vacation. We were just driving and hiking and stuff. And I went to this bougie little breakfast place with Allison and it was $8 for a cup of coffee.

Stephanie Goss:
Oh, my God.

Dr. Andy Roark:
$8 for a cup of coffee and it was very good coffee, still eight bucks for a cup of coffee. And then I ordered a breakfast thing and they brought a biscuit, but they didn't have any jelly for it or anything and it was not where I feel comfortable. That's not where I eat and especially, it made my wife extremely uncomfortable because I asked if I'd had to pay for refills of coffee. And I asked her if the water was free because I was looking into the menu and I'm like, “Is water free? Do I have to pay for more coffee?” And because I was like, “This is ridiculous.” So, anyway, so there I was-

Stephanie Goss:
I could just imagine Alli's face. Okay. Keep going.

Dr. Andy Roark:
I was like, “Is water free?” And she was like, “Ah.”

Stephanie Goss:
Again, “I can't with you.”

Dr. Andy Roark:
I see her jumping back 25 years and going, “Why did I agree to marry this man? This is the man that I married.” So, anyway, so there we are. And I'm drinking this $8 cup of coffee and it's great, but then it's gone. And so, I've got an empty cup of coffee and I've got this biscuit that does not have any jelly on it and this biscuit needs some jelly.
And there's one server and she is busting her hump. She has a smile on her face. She's seating people. She's running around. She's taking orders. Honestly, she's amazing. But there's one thing she's not doing and that's getting me more coffee or coming over, so I can ask for jelly for my biscuit. And minutes and minutes and minutes and minutes go by, and I'm sitting there. I'm turned around, trying to get her attention and she is working as hard as she can.
And so, at one point I get up and I go to the restroom and she's at the bar making this coffee drink for someone. And I said, “Boy, you're really working hard.” And she was like, “Yeah.” And I said, “Is it always this busy?” And she said, “Oh, yeah.” And I said, “Do you always work alone?” And she kind of pursed her lips and she made eye contact and she said, “No.” And I'm sure that someone…

Stephanie Goss:
Called out. Yeah.

Dr. Andy Roark:
… or called out or they have a new hire, anyway. Anyway, I tell this whole story because that person was busting her butt. She did not stop moving and the smile on her face never wavered and I didn't get a refill on my $8 coffee and I never got a jelly on my biscuit.

Stephanie Goss:
Right. You're still frustrated by this. Yeah.

Dr. Andy Roark:
And I'm still frustrated. And guys that's life sometimes, is that everyone can do the absolute best they can and it's still a frustrating experience. And so, I bring that up now because that is how a lot of us live. And so, tell them that you're working by yourself. Tell them how, we know what to expect and know it's not pleasant and know you'd rather not do it. But a lot of that, and a lot of it us start doing some weird Weekend at Bernie's thing where we're like, “No, he's fine.” We're acting like our corpse friend is alive. It's ridiculous. Everyone can tell. It's not exactly.

Stephanie Goss:
We've just dated ourselves because there's a ton of people listening to the podcast who have no idea what that movie is.

Dr. Andy Roark:
Yeah. Oh, yeah. If you want to see something weird and ridiculous and you don't know what Weekend at Bernie's is, go and YouTube, the trailer for Weekend at Bernie's and say, “Andy Roark says that's what we're doing.” A lot of us are pretending like we're fully staffed and we are not.
And so, anyway, pick your poison. Be honest. You can be vulnerable. You can be honest and you can be professional. You can set clear expectations and set them up front. And I tell you a lot of the stress goes away. Practice. Talk to your staff about how to communicate that and then let pet owners know what their expectation should be. And if they don't like what you're telling them and they decide to go somewhere else that is okay.

Stephanie Goss:
Be okay.

Dr. Andy Roark:
And it better be okay because you're burning out.

Stephanie Goss:
Yep, yep. Yeah.

Dr. Andy Roark:
And the last part is when we talk about training our staff, train them how to tell people that we're not taking any more walk-ins today. And set a time. If you close at 6:00, tell people you don't take walk-ins after 5:30 and mean it. Don't make it some, “We don't take walk-ins after 5:30 unless the doctor says that it's okay.” And they say, “Well go ask the doctor if it's okay.” And remind them of all the times I've come here and tell them how far I drove to be here and that I'm having terrible hardships in my life. And then they tell the doctor and the doctor folds like origami every time.

Stephanie Goss:
Every time. Every time. Bless their hearts. And I love my doctors for doing it.

Dr. Andy Roark:
Sure.

Stephanie Goss:
And at the same time, this is where it's really important. When you're in this overwhelmed mode, this is where as a leader, a lot of the head space pieces that we talked about in last week's episode, it has to start with you. And this is a piece, the communication piece, the training piece, the decision-making piece about what are we doing has to involve the team. And there's a lot of practice owners that are like, “But I have to decide what's best for the business.” And that is true.
And your people are going to leave if you don't take care of them. That is also true and so, this is where asking them for their input. It doesn't mean that you're going to go the way that they want you to, but they have to feel heard. And this is where you have to step back and say, “Okay. My doctors want to take care of all the patients.” And a lot of them are paid on ProSal. And so, a lot of them are motivated by taking care of all of the patients, so that they get paid. Those two things are true.
And it doesn't mean that the team having lives outside of the practice is not as important as paying your doctors. Those things have to exist together and this is where you have to have the conversation. And the team has to be able to agree on some of what your standards or your timelines or like you said, Andy, like if your cutoff is going to be 5:30 or 6:00, there has to be conversation. Because no one is set up for success if your hours are 8:00 to 6:00 and you see patients literally from the minute you're open until the minute 6:00 rolls around on the clock, your hours are 8:00 to 6:00, but your team is going to be there at least until 7:00.
And if you're staffing them to only be there at 6:00, you're setting yourself up for failure every time. And so many of us do it because we think we're going to say no at 5:00 and we think we're going to say no at 5:30. And we might have all of the best intentions in the world, but if the whole team isn't on board, if there hasn't been a discussion about it, if you don't have an actual plan like you were creating the business model that your team is there until 7:00.

Dr. Andy Roark:
Yep. And if you want to let people walk in and you're going to take these cases and you know that you're not going to turn people away, that's not wrong.

Stephanie Goss:
No.

Dr. Andy Roark:
It's not.

Stephanie Goss:
Nope.

Dr. Andy Roark:
But own it, and staff for it and budget for it. And have a fair system about determining, who's going to stay late so that the nice doctor and the nice tech don't get screwed over again and again and again. And the people and I say nice, but the people who go, “Nope, I'm not doing this,” they benefit every time.
And so, I just see that all the time of like I say, I'm like, “Hey, who stays late?” And they're like, “Oh, Carol. She's single.” I'm like, “That sucks. That's not fair. That's not remotely fair.”

Stephanie Goss:
What happens when Carol has something to do?

Dr. Andy Roark:
Yeah. You can do an on-call system, but for God's sake, schedule it, communicate it, talk to the team about it. The Uncharted approach that we teach a lot, there's nothing wrong with sitting down and talking to the team and saying, “Guys. This is the reality and people come in and they want our help. At the end of the day, what do we want to do? Do we want to say no and make it no? Do we want to take it on a case-by-case basis? Do we want to plan on this and make a system?”
And you don't have to commit to anything the team says, but man, you can go a long way in making them feel heard. You got to really listen to them. But if every one of them is like, “No, no, no,” then that's your policy. And you go, “Listen, we talked to them. They said, ‘No, no, no, no, no.'” They told you. And if you say to pet owners, “I'm sorry. We do not have the staff available to do this. We cannot see you. These people, their shift is over and they're going home.” And I wouldn't say exactly that, but you get my point.

Stephanie Goss:
Right.

Dr. Andy Roark:
Then that's what it is.

Stephanie Goss:
Yes. And I think goes back to your point about when you go into a restaurant and they tell you it's going to be two hours for a table, they are setting clear expectations for you. You can wait two hours for a table or you can leave. Those are your choices. And I think in Veterinary Medicine like so many of us reach for the, “We want them to understand.” We want them to not judge us. We want them to not look at us negatively and so we overshare.
And so, this is why a lot of us don't communicate when we've gone from a four-doctor practice to a one-doctor practice because we do it and we either overshare or we're afraid we're going to tell them too much and so, we just don't say anything at all. And the reality is this requires finesse and it requires education and your team has to know what to say and how to say it.
But you can absolutely educate them to channel that front desk host at a restaurant and be able to communicate to our clients, “This is what I can do for you. I can seat you in two hours. I can see Fluffy in two hours,” or “You're welcome to call and see if any of the other practices in town can see you sooner,” like that. There's nothing wrong with communicating those boundaries. And I think systemically in Veterinary Medicine, we want to help take care of everybody and so, we've been afraid of that and we have got to get over that.

Dr. Andy Roark:
Yep. That's like the hostess at Olive Garden is not going to run after you and be like, “Please, don't leave. Please, please, wait.” No. We need to move a bit more than that.

Stephanie Goss:
You're 100% right.

Dr. Andy Roark:
Yeah. We to move a bit more in that direction of putting our oxygen mask on ourselves. I want to move past scheduling here.

Stephanie Goss:
Okay.

Dr. Andy Roark:
I want to talk about sacred cows.

Stephanie Goss:
Okay.

Dr. Andy Roark:
Sacred cows are the core beliefs that you have that you believe cannot be touched in your practice and so, part of this is examining your sacred cows. What are the restraints that you have put on yourself and your practice because it just seems like this can't be changed and it's holding you back. And I'll give you an example of this. Well, first of all, the first example of sacred cows is referring to other practices and saying, “We can't get you in, but here's another practice that could see you,” or “Yeah, there's three other practices nearby who might have availability.” And you go, “That's heresy.” And I go. That's your sacred cow. I just poked your sacred cow.”
The other one is we have to be open every day. We have to be open on Saturdays. Surely, we have to be open on Saturdays. It's our busiest day of the week. And I'm like, “It's your busiest day of the week and you're burning out and drowning.” It is not heresy to not be open on Saturday if you can't staff for six days a week. I mean that's it. We have practices in Uncharted that are closed on Wednesdays and people are like, “That's not allowed.” I promise you it is. No one is going to show up and be like, “You have to be open on Wednesdays.” We have practices that are open Monday, Tuesday, Thursday, Friday and Saturday half day and that's their week. And they're like, “Yeah, everybody is off on Wednesday. Everyone gets Wednesday off.” That's great.
Or they'll have one front desk person there or they'll have one front desk person who works from home and like yeah, you're on the phones, but you can be in your pajamas and you can be home and that's what it is. You could do a million things. What are your sacred cows? If you are buried, you don't have to be open. We have lots and lots of practices, I see it especially on smaller practices or one vet practices, they're not open on Saturday.

Stephanie Goss:
Yeah. And I think that from a leadership perspective, I think, I'm going to speak for myself here, a lot when I was a younger manager, I was afraid to poke the sacred cows. But I was also afraid to change those kind of things because I didn't know how to smartly make the decision. I looked at it and I said, “Well, I can't staff Saturdays and everybody's burning out.” And so in my head I think, “Well, it seems like closing Saturdays is a good idea.”
And I think a lot of us struggle with like, “But is this just a gut feeling? Do I go with my gut here?” And a lot of us struggle with knowing, I did, with how do I crunch those numbers? How do I look at those things? How do I smartly measure? And this is where numbers need to be your friends, because to your point, Andy, you should be able to look at that. Is Saturday really your busiest day of the week? You should be able to audit that in your software and tell down to the minute what your busiest day is. And if you can't do that, you can grow in a lot of ways by learning how to do those things.
And don't like don't be afraid of what you don't know. Don't be ashamed that you don't know how to do any of that because there are plenty of us, myself included, who have sat there and gone, “I have no idea. How do I calculate that?” And that's where I love our community, the Uncharted community because…

Dr. Andy Roark:
I was just going to say.

Stephanie Goss:
… how many times have I gone, “Okay, I need to do this math in the clinic. How do I actually do this?” And phone a friend and just ask. There's no shame in saying, “I don't know how to do this,” because most of us didn't go to business school. That's why I went to vet school. There are some who also have MBAs, but lots of us didn't go to business school.
And so being able to say, “How do I make these decisions?” Because you shouldn't make it in a vacuum. You should listen to your team. You should weigh in and you should be able to poke those sacred cows. And also then, a lot of us sit in that place of fear and paralysis in terms of decision-making because we don't know how to make the decision.

Dr. Andy Roark:
Yeah. I feel like we're plugging Uncharted a lot and it's just, it's because we're talking about big action steps that we don't have time to unpack everything. Stephanie Goss teaches a course in Uncharted and it's in the Knowledge Library and we run it fairly regularly on key performance indicators and financial dashboards and things like that. So, if you're like, “I have no idea how to even figure these things out,” we got you buddy. Check out the Uncharted community.
But anyway, you don't have to be open on Saturdays. And I'm not saying, I don't want people to go, “Andy Roark says we shouldn't be open on Saturdays.” I didn't say that. I'm saying it's not a sacred idea. Here's the other thing. I'll really blow your mind. What if you're open one Saturday a month? What if you're open every other Saturday and say, yes, there's communication challenges there, but that's not out. It's not illegal.
The other thing is just because you're not open for Saturdays right now, it doesn't mean that you're not going to open back up for Saturdays in three months. What if you said, “Hey, we need to hire two doctors and when we do hire two doctors, we're going to open back up on Saturdays.” And doctors coming in will know that that's the plan and that's where we're going.
It doesn't have to be a scary thing. It can be, “Right now, we're not able to keep Saturdays open.” And that's where we are. And we hope to open back up on Saturdays, so when people say, “I wish you were open on Saturdays,” you could say, “Me, too, buddy. We are working toward towards it.”

Stephanie Goss:
We are working towards that.

Dr. Andy Roark:
Exactly.

Stephanie Goss:
Yeah. And it goes on both sides. You have to communicate that to your clients and you have to communicate that to the team. And I think that that's important. We have to set expectations, and that's where a lot of us struggle.

Dr. Andy Roark:
I agree. So, look at your sacred cows. There's a lot of people who just the idea being closed on Wednesday or every Wednesday afternoon, that seems terrifying and wrong to some people. And I go, “No, it's not wrong. We got a lot of practices that do it.” If that's what you need in order to serve your capacity, if you say, “We're closed on Wednesday and we are working at maximum capacity every day we're here,” I'd say, “You're doing it right.”
Are you priced appropriately, so the numbers make sense and your business is healthy? If the answer is yes, then go forth and carry the torch. That's awesome. And the last thing I'm going to talk about before we run out of time, and a lot of people think this is the first thing, it's not, it's the last thing. It's efficiency. And people are like, “Yes, tell me how to not change anything except get more work done, doing things exactly the way that I'm doing them now?” And I go, “That's not what this means.”
You might be able to increase efficiency. The problem, the honest to God tactical on the ground problem, is increasing efficiency often involves training. And if you're already overwhelmed and drowning, it can be extremely hard to do the training required to change your operation system while keeping your nose and mouth above water. And so, I'm not saying you can't do this.
Generally, like most things, a multimodal approach is going to be your saving grace. And so, you might close on Wednesdays and then use Wednesdays as training days to reevaluate your workflow, how you're moving people through the clinics. And guys, the biggest thing we talk about efficiency, the easiest go-to in most practices is, “Are you leveraging your support staff? Are your techs doing stuff that they could be doing or is everybody waiting?”
The quick thing I'm just going to say on efficiency and making it work is just like we started at the beginning and said, “You need to do some analytics. You need to look at your workflow.” You need to look at what's actually happening and gather some data. You need to do some data gathering on how pets are being seen in your practice and you need to look for bottlenecks. Where are the places where support staff are standing around waiting for a doctor? Where are the places where the doctor is standing around waiting for support staff? And we need to make adjustments.
And that honestly often runs into your sacred cows. People will say, “Well, our support staff get the histories.” And I'm like, “Is the doctor waiting in the treatment room for you to get this history.” I say, we need to look at that and have an audible that can be called where the doctor is free and we're going to have a modified-

Stephanie Goss:
They're just going to have to do it.

Dr. Andy Roark:
Yeah, we're going to have a modified doctor's ready to-go history that gets us into that room. And even say to people, “Guys, this is a way that we're going to run this while we're shorthanded and we're going to come back to it.” Are there things that the doctors are doing that the techs could do? And that's an easy one. It's like, “Hey, buddy. You got three technicians for every doctor, or you got one technician and an assistant for every doctor.
You need to get smart and look at how things are getting done and reallocate the workload there because a lot of times I can take some work off that doctor's plate and that is the rate limiting step. And so, anyway, and last of all, you look at efficiency, but know that you're probably going to have to poke some sacred cows. You're probably going to have to set some boundaries and change some scheduling stuff up. You're probably going to have to figure out how to do some training, communication training, maybe technical training to make this happen.
It is not simply, “Let's shift some things around. This is a bit of a process, but if you're committed to it, it's going to take some time. But week after week, walking in the rain, put one foot in front of the other and walk that training through your practice. Get people on board. Make small steps. Make small changes and keep making changes, you will be okay and you will come out the other side.

Stephanie Goss:
Yeah. I love it. Ooh, this is a good one.

Dr. Andy Roark:
Yeah. Boy, I'm really glad we decided to split this into two. Now, that we're in it, I'm like…

Stephanie Goss:
Could you imagine?

Dr. Andy Roark:
… I was rushed at the end. They are trying to get everything out and holy moly, yeah.

Stephanie Goss:
Oh, okay. Our first two-parter in the books. Have a fantastic week, everybody.

Dr. Andy Roark:
Yeah, everybody.

Stephanie Goss:
Take care.

Dr. Andy Roark:
You guys take care yourselves.

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

Overwhelmed and Won’t Give Up! Part 1

Uncharted veterinary podcast episode 204 cover image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss jump back into the mailbag to make history. That's right, we got a topic we loved so much this week that we are splitting this episode into two! This week, we will dive into the headspace of the challenge facing our repeat mailbag writer who was previously feeling squashed and stubborn. They are still at it and just as stubborn as ever, only this time, they are struggling with not letting client frustration over scheduling woes get them down. They are booked pretty far in advance and doing all the things they can to manage the schedule and clients are still really frustrated. They are voicing it to the team and it is starting to crop up in online reviews and this doctor is asking for help in getting into a good headspace and not letting it get them or the team down. And also looking for help on how to communicate to clients that they have to wait and why it's okay to wait in some cases, without clients feeling brushed off. This was a super fun challenge of an episode – don't forget to stay tuned next week for part two – the action steps! Let's get into this…

Uncharted Veterinary Podcast · UVP – 204 – Overwhelmed And Won't Give Up! (Pt. 1)

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

Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag


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The Secret Sauce to Optimizing Workflow with Senani Ratnayake, RVT

Back by popular demand! It's time to take a look at the workflows that aren't working and come up with a plan to move forward with a strategy that makes sense.

Date: November 30

Time: 5:30pm ET/2:30pm PT – 7:30pm ET/4:30pm PT

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Episode Transcript

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This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Andy Roark:
Hey Stephanie Goss, you got a second to talk about GuardianVets?

Stephanie Goss:
Yeah. What do you want to talk about?

Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing. And I'm sure you hear from these people as well, like our caseload is blowing up and the doctors are busy and the phones just don't stop.

Stephanie Goss:
They never stop. That is a true story.

Andy Roark:
I'm amazed by how few veterinarians knew about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and GuardianVets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.

Stephanie Goss:
Pre pandemic it was amazing to me how many people hadn't heard about it for after hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well, which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls. And so we talk about it. We've talked about GuardianVets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”

Andy Roark:
Guys, if you're not familiar with GuardianVets, if you think that you could use them help on the phones or up the front desk, check them out. It's guardianvets.com. And if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardianvets.com.

Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. And this week on the podcast, Andy and I are making history. That's right, we had a fantastic email from the mailbag and I'm going to set it up in just a second. But it was so good that we decided to split this episode into two parts. That's right, we're tackling headspace and we're tackling action steps, but we had so much great conversation about this specific topic that we decided to make the headspace part one and the action part two. So if you love this week's episode, stay tuned because next week will be part two. We're going to cover all the action steps and we hope it's worth it for this little bit of a lengthier than normal episode because this is a fantastic topic that came to us from Squashed but Stubborn.
I just want to take a quick second and give a big shout shoutout to our friends at Banfield Pet Hospital for making the transcriptions of this podcast possible. The podcast transcripts are brought to you, thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity all across the veterinary profession. If you would love to find out more about the DEI initiatives for Banfield, you can head on over to the link in the show notes. And now let's get into this, shall we?

Announcer:
And now the Uncharted Podcast.

Andy Roark:
And we are back. It's me, Dr. Andy Roark and the one and only Stephanie, I'm a hard working Goss.

Stephanie Goss:
I do. I feel that this week. It is a hard working time of year. How's it going Andy Roark?

Andy Roark:
It's insane. It's insane and it is a very hard working time of year. Holy cripes, we got a lot going on.

Stephanie Goss:
Hell yeah.

Andy Roark:
We got two new uncharted team members last week. Last week we got two new and they are both bad A, bad mamajamas. People aren't going to even recognize Uncharted in about three years. We've got Batman's secret lair and we've got a lot of people down there building a bat mobile or two or three. It's going to be freaking nuts. So anyway, we've got awesome stuff going on here. How are you doing?

Stephanie Goss:
I'm good. It is busy. We have a lot on our plate. And it is that time when we're recording this, it's right before we do Get Sh*t Done. And I'm super, super excited about that. And then you and I and one of our other team members have an event the week after and it's just busy, busy, busy. And it's busy with the kids. So it's that time of year the weather is changing and it is crazy, but it is good. I'm here for it. I'm along for the ride.

Andy Roark:
Well, you write the book you need to read. It's like we put on the conference, we need to have… I'm like, “Boy, we really need a Get Sh*t Done conference.”

Stephanie Goss:
When you're overwhelmed.

Andy Roark:
Yeah, exactly right. When you're overwhelmed. That's exactly… Like, let's get some smarter people than us in here. Yeah, no it's funny. Boy, it's a stressful time here. Two stressful things. Tomorrow we go to the hospital. Allison's going to get the nasty little lump in the breast tissue under her left arm removed. And so that's a big time for us and our family and so a little bit stressed about that. And then the other stressful thing, I would say equally stressful, is on the advice of behaviorists that I interview on the other podcast I do, Cone of Shame-

Stephanie Goss:
Oh, no.

Andy Roark:
I moved my bad dog, Skipper, to food puzzles for his meals because he needs intellectual stimulation and he-

Stephanie Goss:
How's that working out for you?

Andy Roark:
He does not agree that food in a food puzzle is one of his two meals. That's it. He has chewed up the measuring cup and all the other things. He is still convinced that he is supposed to get food in a bowl twice a day and a certain amount of food in a bowl. What is being introduced in the food puzzle, he does not see that as a substitute for it.

Stephanie Goss:
Sure.

Andy Roark:
Which I kind of get because if you gave me a lasagna in a lockbox and I got into it and you were like, “Well that was your dinner,” I'd be like, “Oh no. Dinner comes on the table.”

Stephanie Goss:
Right.

Andy Roark:
“Dinner's on a plate. This was just lockbox lasagna. This is extra.

Stephanie Goss:
Lockbox lasagna. I love it.

Andy Roark:
Yeah. So I get it. But he'd chewed up the measuring cup this morning.

Stephanie Goss:
Oh gosh.

Andy Roark:
Yeah, that's where we are.

Stephanie Goss:
He's one of a kind. That's going to work.

Andy Roark:
Yeah. Oh wow.

Stephanie Goss:
Oh man. Well, I am-

Andy Roark:
Well, that's how things are going here.

Stephanie Goss:
I am super excited. We have got a letter from a practice owner, and this excites me because I think it falls in line with a lot of the kind of questions that our community members have been asking and we're getting ready to Get Sh*t Done in a week, but then we're already thinking ahead to December for our Practice Owner Summit. And I'm super excited to tackle questions like this because I think so many practice leaders and practice owners in particular are feeling overwhelmed but also feeling this fighting spirit of like, “I'm going to figure this out.” So I love seeing questions like this.
It came to us from our previous writer in the mailbag who said, “This is how you know me. And I'm still stubborn, but I am in a new place and I am feeling a little bit apathetic, which is not me.” Their clinic is scheduled weeks out and have gotten to the place where they're not taking new clients. They lost half of their licensed technician team in the last year and they lost two and half doctors to it sounds like retirement and life. So nothing that anybody can control. Just had some changes. “I say two and a half because one of the doctors that retired this year has already come back part-time to help us out because we're so overwhelmed.”
They said, “I can't get my regular clients in. I'm struggling with what to say and how to say it when it comes to us not having an appointment for their first time issues for things like never been itchy before and now has flaming allergies or has crazy diarrhea.” These are things that they know that they need to be seen for and they want to get them in and they just don't have a space to do with them and to put them.
This practice owner was like, “Look, I know what to do with the immediate, urgent fire things that we can't handle, but what do I do with those things that I know need to be seen but won't go to the emergency room and I can't see them for days or weeks and I'm struggling to explain it myself. And also my team is struggling to explain it to clients in a way that isn't then opening up the doors to negativity and criticism.”
And so this doctor was like, “Look, I've been the anti negative review person for a long time, but really the client's reviews matter to me. Don't tell anybody. Don't tell, but it does. I take it to heart. It matters. And they're struggling. What do I say? Like, ‘I can't help you because my client or my doctors are about to go get other jobs because they're too overwhelmed and they're too overworked'? I feel like I'm running out of ideas and I need a strategy.”
They are just in that rut where they are overwhelmed, they have too small of a staff to handle their patient load. Everybody's constantly in training and they just don't know how to direct that energy at clients in a way that doesn't feel negative when it feels like clients are just like, “Help me, help me, help me.” And so he said, “I need help. Sighed. I can't give up. I won't.” And I just loved this question because they are not alone. We get this question a lot. I think it's just such a good one for us to tackle as we head into what's another usually crazy part of the year for most clinics.

Andy Roark:
Yeah. This is the defining question of vet medicine right now, in my experience. This is the question that people ask me all the time. There is no beautiful, “Hey, I have the solution you haven't thought of answer.” But there are absolutely best practices, and I think that's really important. I was really glad to see this question come through the mailbag because we got a lot of experience answering it at this point. There are best practices, there is really good headspace that I personally think is really, really important. And I want to try to lay it down eloquently today if I can. But headspace, it really matters.
And then the other thing is what can you actually do and what can you actually control? I think that there are things that you can do and that you can control.

Stephanie Goss:
Yeah, totally.

Andy Roark:
I'm excited to get into this and start to lay this stuff down. You ready?

Stephanie Goss:
Yeah, let's do it.

Andy Roark:
All right. So let's start with some head space.

Stephanie Goss:
Okay.

Andy Roark:
Okay. All right. I don't know what happened with their doctors, things like that. There's two contributing factors. One of them is what I call walking the rain and one of them is called the death spiral. So I'm going to talk about both of them in kind of how I see this, but I know that I don't have any more information than what you guys just heard from this mailbag. So anyway, that's it.
All right. I mentioned starting this podcast that tomorrow my wife and I are going to the hospital to deal with this breast cancer. And it sucks, my friends. I do not recommend… If anyone's like, “Hey, you want to try breast cancer?” You should say no. You should say no. If you are given the option, hard pass. Hard pass. My wife is… She wouldn't mind me saying this. She's 43 years old. Why does someone who's 43 have breast cancer? Why does that happen? And the answer is, I don't know. I don't know what happens. I don't know why sometimes we end up with a bunch of patients and we can't hire people. You know what I mean? I don't know why sometimes really great staff members move away and go to somewhere else. I don't think we did anything wrong. You can't convince me that we did anything wrong.
Sometimes through no fault of our own, we have to walk in the rain. And that's kind of how I put it, is because I don't have any control. You guys have probably heard me talk in the podcast before. I think that I say we're all backpackers. And that's really what I believe. I believe that we're all out exploring this profession in this world and we're all walking. And hopefully we find good partners to walk with. Sometimes we walk with a team. And that's great, but at some point we're all walking. And we all walk and sometimes we get beautiful views and sometimes we get eaten by mosquitoes and sometimes it pours rain on us.
There's really not a lot of options that we have other than be smart in how we pick our paths. And if we find ourselves circling back to the same spot again and again and again, we need to pick a different path. We need to change that. But there is truth at some point you're just going to walk and sometimes you're going to climb big hills and there is no path that does not have hills on it and there is no path that doesn't have mosquitoes on it and there is no path that doesn't get rained on.
And so sometimes guys, we just get rained on and we have to walk in the rain. We can be angry about it or we can be sad about it or we can sing a song while we get rained on. That is generally the power that we have. But we have the power to choose our path. But you should still know that every path gets rained on. And so I put that forward first when I say sometimes staff leave. So many of us are shorthanded. And guys, it's really, really hard to hire people right now. And I'm talking about across the US and Canada. Boy, it is very, very difficult to get people. We have a labor shortage. And so if you're looking around and you're like, “Gosh, I can't hire people and we've got a ton of work,” I want to put forward the idea that you're probably not doing anything wrong. You're probably just walking in the rain like the rest of us are. And so I want to remove those feelings of guilt first of all.

Stephanie Goss:
Yeah, I think the other thing that's really important about the metaphor, because I think it's such a good one and it's certainly more positive than thinking life sucks sometimes, right?

Andy Roark:
Yeah.

Stephanie Goss:
That's how I looked at things for a really long time. But I love the idea that yeah, it does, but you just have a choice. I think the danger is that there are people in the world who are eternal optimists and who always try and look at things on the sunny side and who will look at this and say, “You can choose to sing while you're walking in the rain.” There are certainly times where that is the tool that I want to reach for. And I also just think that it's important to say like, “Sometimes you need to just sit in the rain and cry,” right? And that's okay too. Sometimes somebody joins you and then you have a friend. Sometimes you run to try and outrun the mosquitoes.
The reality is the choices that you're making are not wrong. I think this is one of those places where it's really easy to beat ourselves up because we are perfectionists in veterinary medicine and it's really easy to focus on, “Well, I feel really, really crappy about this and I'm sad and I'm mad and I don't know what to do to help my team and I feel lost.” And it's really easy to add more emotions to that by letting yourself sink into the guilt by feeling like, “Well, I should figure out how to sing in the rain and be happy about this.” I think it's really important to acknowledge all of the emotions are valid and you're going to go through all of them. That's the whole point. It should always be this cycle.
And at some point, if you sit there in the rain too long, you're going to get pruny and you're going to have side effects from it. And so yes, you shouldn't sit there forever. There should be then the place where you pick yourself up and you figure out how you start walking again, right? But in the moment, don't let yourself feel bad for wherever you are on that journey. And if you need to stop, you need to stop. That's why I loved how they started with, “Okay, well I thought a stopping point would be not taking new clients. And so I did that thing,” right?

Andy Roark:
Yeah, totally.

Stephanie Goss:
So I think it's really important to acknowledge that there are places along the way that all of us are going to stop and there's nothing wrong with that.

Andy Roark:
Right. I agree. Well, that's another part that I put to this backpacking metaphor, is if anyone who goes out in backpacks, you better take breaks. There's no scenario where you get up and you put your pack on your back in the morning and you walk all day and you never stop and drink some water. Breaks are required to enjoy backpacking. If you're walking and walking and you never stop to rest for a minute or have a snack or have a drink of water, I think you're doing it wrong.
There are some people who sit down and take a break and just never get back up and get going again, and that's not good either. But again, and I'll move on past this metaphor in a second, I really like the idea of just imagine that you're walking in a crappy place. There is a desire to hustle to get through that place. And I think that that's good. However, there's also a thing where you say, “This is a big stretch of bad place. I'm going to have to take some breaks here. I cannot sprint five miles down this trail. I can't. I'm going to have to walk. I'm going to take care of myself. I'm going to take breaks. Even though it's not where I want to be, but I'm going to rest because I can't push myself and I can't push my team hard without stopping to get through this to come to the other side.”
And again, if it's raining, you can push yourself as hard as you want. It's still going to rain. So anyway, that's it. But I want to put that forward because I feel like when we start talking about this, I think a lot of people are wrestling with a lot of guilt. And I just want to put forward that, “Hey, this is probably not about you. This is a hard time for a lot of practices.” And there's not a magic answer. Sometimes we walk in the rain.
And so I think to our writer I would say, “Hey buddy, you're walking in the rain, and that's all right.” I don't expect most of us to sing in the rain. I'm not pushing those sorts of things. But I would say the most enlightened of us can still enjoy the views even when it's raining when we come to them. And I really think that's the key. If you are miserable in the rain and you can't enjoy the views and you can't enjoy anything at all because all you can focus on is it's raining, I think that's a really hard, really dark place to be. I think enlightenment is being aware that it's raining and still saying, “You know what? I'm going to appreciate where I am and I'm going to appreciate what I have. I'm going to stop and I'm going to celebrate the beauty that I find even though it's in the rain.”
So anyway, that's the first thing I talk about. So I want to put that head space out and say, “Hey, sometimes we walk in the rain and we need to put the guilt aside.”

Stephanie Goss:
Sure.

Andy Roark:
The other part of that I see in a lot of practices that are in this place is what I call the death spiral. The death spiral is this, it's where we say, “I am super overwhelmed and we have so much to work to do. There's nothing we can do but put our head down and work, work, work really hard to get through it.” And what happens is, and we have the best of intentions, it is 100%. It's not about, “I want to make all the money. It's not that.” It's, “People need my help and I need to go and there's no other alternative but to put our head down and just work, work, work.” And what happens is you burn out your people.

Stephanie Goss:
Sure.

Andy Roark:
And they quit because they don't own the practice. And so they say, “I'm miserable. I'm stressed. I'm burned out. I come home and I cry at night. My spouse is telling me that this is not acceptable.”

Stephanie Goss:
[inaudible 00:20:12]. Yeah.

Andy Roark:
“This is affecting me. I have to take care of myself and I'm going to leave.” And basically going back to our backpacking metaphor, this is someone that we forced marched to the point that they say, “I'm not hiking with you anymore. I'm getting off this trail.” And they leave. And now you're in a worse place because you have fewer team members. You know what I mean?

Stephanie Goss:
Yeah.

Andy Roark:
And I saw that. I saw this during the pandemic it was a big one because I saw people put their head down and work because they thought that was the answer. And then they burn their people out and their people quit. And now they have just as much demand for their services with a smaller team. And so that goes back. And all that stuff ties together and it's really important. Like I said, a lot of times people leave because their spouse gets another job or they get another offer.
I had one of my favorite doctors in the world say to me that he had just lost one of his licensed technicians and he said, “I can't blame her. She got a job 30 minutes closer to home and at $6 an hour more than I can pay. I can't blame her for taking that.” And I was like, “Good. You shouldn't blame her for taking that. And you also shouldn't feel guilty if you can't magically make her be 30 minutes closer to…” I mean the 30 minutes is a big deal and then $6 an hour. If you can't pay that, then you can't pay that and you shouldn't beat yourself up about it. But you should also not hold it against her or feel bad that she went to this other place.
So I think a lot of it is that accepting where other people are and knowing, “Okay, I cannot drive these people. If I drive these people until they quit, then now I'm making this worse. I can't control the rain, but I can control whether or not we let people rest and how we take care of them and how we respond. And so anyway, the death spiral is the other part of this that I see where people say there is no answer but through as hard as we can go. And you end up burning your people out and then you lose them. The patient number doesn't go down, it stays the same but you're more shorthanded.

Stephanie Goss:
Hey friends, there is a workshop coming up that some of you are not going to want to miss. This last weekend was Uncharted Get Shit Done. There was a lot of conversation about workflow challenges in our practice and how a lot of us are struggling with things not working very well. Things feel pretty inefficient. We're all struggling to do more with less, less time, less people, less resources. There was a lot of conversation about how do we get more efficient and effective in our workflows.
And so while a lot of you were there with us this weekend, not all of you were. And so I want to give you all an opportunity to join us coming up in November, November 30th at 5:30 Eastern, 2:30 Pacific, we are offering a two-hour workshop with my dear friend, Senani Ratnayake. Senani is an RVT. So she is a licensed technician, she is a general badass, she is a practice management consultant and she loves talking about workflow. And so Senani has agreed to come back and lead a workshop that was voted one of our most popular in all of 2021 in Uncharted, and that is the Secret Sauce to Optimizing Workflow. This two-hour workshop is here to help you and your team dissect your workflow so that you can get out of the place where everything feels inefficient and ineffective. So if you are struggling with efficiency and effectiveness in your practice, head on over to unchartedvet.com/events and sign up for the workshop. We would love to see you there. And now back to the podcast.

Stephanie Goss:
I think this is one that is really hard for a lot of leaders to wrap their heads around because they care so much about their patients and they care about their teams too. They care about their clients, they want to make everybody happy, right? We're a field full of perfectionist people pleasers. Let's be honest about what we are. And so there are a lot of leaders who look at it and say,” Well I just want to take care of the patients. Everybody let's huddle together and let's support each other, but also let's lean in and just do the thing.” I think that it's done with the best of intentions.
The thing that I always struggled with, and I had several partners in practice, whether it's medical director or a co-owner, where we butted heads about this because it is not a single option here because the other side of this coin is that there are people to take care of and there are people to consider as well. We want to do right by our patients and at the same time we also need to do right by our clients and our team. It's really easy to reach for the pet lever and pull it because we all have empathy. And even the people who are here because they people care about the patients and care about the animals. And so when we say like, “Let's just put our heads down. Let's take care of all of our patients. We want to be there for them,” that's a really easy one. And I think it's one to remind ourselves like, before you pull that lever is really important to take the step back and look at it from the people perspective as well.
I say this for two reasons. One, to the point you brought up, Andy, which is that if you put your heads down and just work and work and work, and I saw this with lots of my colleagues during the pandemic, people will leave. They will 100% leave. They'll get overwhelmed, they will burn out and they will leave. And then you are worse off.
And also we are superheroes, all of us. We do amazing things for our patients every single day. And at the same time, what level of medicine can we practice when we're down three or four people? Can we be our best team of superheroes when we are not rested, when we worked a 16 hour day, we went home and slept for five or six hours and then we come back and do it again? The reality is you can do that for a short period of time, but that's not sustainable long term. And that's where I think it's important to think about the people side of it.
The other piece that I encourage a lot of us to think about that I think we don't, we should think about it more than we do is the client piece of it. Because just as much as we are there for our patients, we also need to be there for our clients. And are we serving our clients if we are driving our teams to take care of our patients and we are overwhelmed and we are running behind. And now we shift the business model so that clients are constantly on hold, they're waiting hours because we've taken in more patients than we can see, they're not getting calls back. And we are doing our best. Don't get me wrong. We are trying to take care of those clients. But are we serving them in the best way possible when we just put our head down into, your point, go into that death spiral and focus solely on, “Let's just take care of the patients. We have to be there to take care of the patients”?
And so I think it's really, really important to consider that you cannot pull one of these levers, either of them, pets or people, without it becoming a lopsided equation. And so I think it's really, really important from a head space perspective to consider the fact that we have to consider both sides of it and really try and figure out how do we strike that balance. And it's hard. Don't get me wrong. I have done this. I have done this wrong. I have had it go well, but I've also done it really wrong. And so I think it's important piece of head space to keep in mind because so many of us immediately, myself included, can lean into the patient piece of it because that's what we're here for, and forget about the people piece of it, and it is equally important to the balance.

Andy Roark:
Well, that is the leadership challenge, isn't it? I mean, it's the classic challenge of getting the most out of your people so that you can pursue your goal, your mission, your purpose, the reason that we do this. We need people to work hard and we want to get the most out of them. But you can push that too far until they break and people say, “Well, where is that line?” And I go, “Boy, that line is a moving target, isn't it?”

Stephanie Goss:
Yes.

Andy Roark:
And sometimes your people… I mean, I've had it with our team. With our team, there was a time everybody on our team was sick. It was funny. We had COVID go through our office, which is funny because we're virtual and we lived hundreds of miles apart from each other, yet we all got COVID. Like within two weeks, I got it.

Stephanie Goss:
It is true.

Andy Roark:
Yeah. We had that happen at one point and you go, “Boy, cracking the whip and really pushing people.” Not “We crack the whip,” but you get the point. We're really trying to push people hard.

Stephanie Goss:
We had a ton of deadlines. Yeah, It was crazy busy.

Andy Roark:
I was like we were busy but also our people were just down and sick and you go, “Look, we're not going to get the work done that we would get done when people are healthy. And trying to get that same amount of work done right now is a bad idea because all we're going to do is really break people.” So it's always that balance of as the leader, you have challenge that every sports coach has, which is “How do I motivate? How do I inspire? How do I get the most out of my people without pushing them to the point that they get injured or that they don't enjoy playing this game anymore and they don't come back?” That's the real challenge that we all have here. And so we need to keep that.
When I talk about getting the most out of people and sort of building this thing and the mission and the purpose in where we're going, the last part I want to bring up in headspace is the sunk cost fallacy because I see this really messing with a lot of people's heads right now.
What happens in the sunk cost fallacy, the sunk cost fallacy is the idea that I have invested so much to get here. Stepping back or changing what I'm doing now feels like I wasted that energy to get here. And so what that looks like right now in a lot of places is we built our clientele up to a certain level. We built, we have 10 exam rooms now and we have been seeing X number of clients a day and not using some of those exam rooms feels like failure. Significantly, reducing the number of clients we see a day, that feels like mega failure.

Stephanie Goss:
Sure.

Andy Roark:
Like, “I worked 10 years to get to this place where we did this amount of cases and everything and now going back down feels like all the energy we spent to get here was wasted.” And that's the sunk cost fallacy. And so the last thing I'm going to call out head space wise before we go into this is to say, “Hey, I see you there. I see you overwhelmed. I see you struggling. You need to not think about what you've done in the past. You need to do the mental exercise of thinking, if you were starting your practice right now today with the team that you have, how many exam rooms would you run and how many patients would you see? And the number of patients that you saw two years ago, that doesn't matter because it's not two years ago, it's today.”
Realistic expectations about if we were starting right now today, what would we service? And the fact that we serviced more last year when we had two and a half more technicians and two more doctors than we have today, that doesn't matter because that ain't where we're living right now.

Stephanie Goss:
Nope. And listen, this is one of the things that I struggled with the most in practice, particularly in my journey as a corporate practice manager, and I'm going to talk to my fellow colleagues here for a second, because when we run our practices from a leadership perspective, it is our job as business people to be concerned about the numbers. I'm not going to lie, that is part of your job. As the business side of the leadership, your job is to think about the numbers. And to your point Andy, our practices should be built on what can we do when we are efficient and effective, right?

Andy Roark:
Yeah.

Stephanie Goss:
How can we maximize seeing and doing the best work for the best number of patients? And we know that when we practice good medicine like that, the revenue follows. And that is good thing, right? And at the same time, it's really, really easy to get caught up in micromanaging or being micromanaged to the numbers. And so a lot of us, particularly those of us who have managed in corporate medicine, say, “Well, we have to see certain number of cases because our whole structure is built on that.”
The thing that I will tell you, and don't get me wrong, it got me in trouble more than once, but I will say I stand by it. The reality is, if your practice, any practice, private corporate does not matter, if your practice can't stand to say, “This month we are going to change things and it's not permanent, but right this second this is what's best for the people. Whether it's the clients, your team, a combination of all of the above, we're going to step back and we are going to see 10 patients a day instead of 25,” or whatever it is that you need to do-

Andy Roark:
That's quite a step.

Stephanie Goss:
But here's the thing, if you go from four doctors to one, going from 25 patients a day to 10, maybe your only option, right?

Andy Roark:
Yeah.

Stephanie Goss:
So even if you can't, you have to be able to take even a radical step like that for a short period of time. If your practice can't sustain that, you weren't running a good business in the first place. You should be able to sustain that for a short period of time, right? You should be able to pivot and do what you need to do for a short period of time. And that short period of time is going to be different for all of us. We are all in different places in our business. We all have different levels of buffer. We all have different levels of reserves in the bank. I recognize that all of those things matter. But if we're running it so close to the line that we have to live forever in the place of sunk cost fallacy and we can't look at things and say, “I am going to make these changes temporarily to take care of my people, to take care of my clients,” whatever the reason is, then we have to change the business model because it's not going to work for anyone long term.

Andy Roark:
Boy, leadership in modern vet medicine is more about advocating up the chain than it's ever been before. Don't you agree?

Stephanie Goss:
100%.

Andy Roark:
Boy, wouldn't it be great if there was a place like a community that you could go and you could work with other people who have the same struggles and advocate up the chain for their people and that would provide ongoing support and guidance and lessons learned and hard fought battle experience? Wouldn't that be amazing?

Stephanie Goss:
Uh-huh. That would be so amazing.

Andy Roark:
God, I can't think of a place like that.

Stephanie Goss:
Neither… I wonder where one might exist.

Andy Roark:
Oh, there's a place, it's called Unchartered Veterinary Community and that is what we do. We have literally hundreds of leaders who are in corporate practice that are also leading teams on the ground. We work with them because that's what we do. And yeah, we 100% help people advocate up and down the chain. And you're like, “No one's ever told me how to communicate up the chain to take care of my people.” I was like, “Well, that's the thing that we definitely do at Unchartered.” So if you're interested in that, then check us out.
Wait, there's one more thing. I said that was my last thing to say and now I'm like, “Oh, there's one more thing I have to say because, and I hadn't planned on talking about this, but then when you were going through what this person said in their letter, there's one thing that popped out and it hit me like a thorn. It was like a splinter and I'm like, “That's going to hang with me and it's going to bother the heck out of me.”

Stephanie Goss:
Okay.

Andy Roark:
This person said their clients won't go to the emergency room, right?

Stephanie Goss:
Uh-huh.

Andy Roark:
And what they were saying was like, it's like an allergy flare up.

Stephanie Goss:
Sure.

Andy Roark:
And they won't go to the emergency room. And it's like, I get it. I can 100% understand the person saying, “I don't want to pay that money to go to that emergency room and I don't want to go there and wait for hours to get seen.” I totally get it for sure. But this is a thing, and this is going to sound maybe a bit harsh, but I need everybody to hear it, right? It is not your responsibility to solve the problem of a pet owner that won't go to the emergency room or they won't go somewhere else. That doesn't mean I'm heartless, it doesn't mean don't care. I totally do care. But in order for you to keep your sanity, you need to know that that's not your pet, and all you can do is advocate and be honest and compassionate and do the best that you can do without burning yourself out, right?

Stephanie Goss:
Yes.

Andy Roark:
Because you giving everything you can today and leaving this profession in three years, that is not the best outcome. And I say this because I can see it in the writing of the person who wrote in. I see all the time guys, the trap in vet medicine is people jump in, they say, “I'm here for the pets and the people and I'm going to take care of them.” And they do everything they can for five years and they burn out and they leave the profession. And I say, “You know what? If you had made some hard calls and set some boundaries that made you unpopular at the time, you would still be here 10 years from now and the net number of people and pets you would've helped is much greater.”
And so the greatest outcome over your life is not seeing everything that you can see and taking responsibility for everything. It is being honest about what you can do and taking care of yourself, working hard of course, but still setting those boundaries. And so it sounds awful when I say it's not my responsibility to handle problems when the pet owner says, “Well, I'm not going somewhere else.” And I would say, your job is to present them honestly with their options and to set clear expectations and let them know what you can do and what you can't do. And that is what they have to decide. So maybe they're not going to take their allergy dog to the emergency clinic.
And here's another thing that's really, really hard for vets to hear. If I can't see your pet because I am swamped and overwhelmed, I'm going to recommend you go to a different vet practice. And people go, “That is harassing. Oh my god.” There's some competitiveness to it. There is some scarcity mentality. There is the fear that one day I'm not going to have enough clients and I'm going to go out of business and we're all going to live in a box by the street.

Stephanie Goss:
Under the tree. Uh-huh.

Andy Roark:
Under the trees. All of those things are scarcity mentality that kick in. But I'm saying is in order to feel whole, is to look around and say, “I can't see you. You're not willing to go to the emergency clinic and pay emergency prices. I don't see this changing in the near future and your pet is having an allergy flare up. My recommendation is that you need to go find another veterinary clinic and I'll send your records over. I hate it, but I'm just being honest with you. I can't get you in and I don't want your pet to suffer and this is what I'm doing.”

Stephanie Goss:
Yeah. I think that is such a struggle for us in veterinary medicine for so-

Andy Roark:
People hate it.

Stephanie Goss:
… Oh my god, for so many reasons. But I'll also tell you it feels like this boring concept, and it shouldn't. Because at the end of the day, we are in the customer service business. And let me tell you, when I was really young, when I was at university, I was a manager for a book chains. It's not around anymore, but I worked for Borders and was the manager for the children's department. I was covering at the customer service desk one day and we had a customer come up to the desk and they were looking for a particular book and we didn't have it in stock and I wasn't going to be able to get it for two and a half or three weeks. And they were just like, “Thanks, but I really wanted to get it.” And I said, “Well, hang on. Do you have just a moment?” I said, “Let me see if anywhere else locally has it.”
The next closest Borders to us was like 45 minutes away. So it was like this poor customer is looking for this thing. And they had told me why and it was for school and it was really important. So I picked up the phone and I called Barnes & Nobles, which was 10 minutes down the street, and I said, “Hey, do you happen to have a copy of this? I'm calling from Borders.” And they put me on hold and then they said yes. And I said, “Great, I have a customer here.” I gave them her name and I said, “I'm going to send her over. Can you set it aside for her at the front desk?” And they were like, “Yeah.”
And that client was like, “Oh my gosh, I can't believe. Did you say Barnes & Nobles? Are you sure?” And I said, “Yeah, it's right down the street. Go ahead. They have it waiting at the front desk for you.” She went. And it was so funny because it was on and she went on her day and I didn't think about it. Later that night I got a page to come to the customer service desk and I go up to the customer service desk and the woman is standing there and she has a bag in her hand and a coffee and she's just like, “I had no idea what you liked, but I just wanted to say thank you. You saved my day for school.” She's like, “I picked it up.” And she's like, “But I just want you to know I'm going to come back here.”

Andy Roark:
Wow.

Stephanie Goss:
“It made a huge difference in my day. And the fact that you would send me to your competitor, that means something to me.” And then I saw her over and over because she would come in once a week to do school stuff. It stuck with me because I just didn't think twice about it. I had a conversation with my manager about it. And they were just like, “Well, but you sent her to a competitor.” And I was like, “Yeah, but she's a loyal client now. She's a loyal customer. She's coming back. So what? So we lost the $10 on that book sale, but look at what we've gained in the long term in that relationship.”
I think it's really important and it stuck with me and I have used that for myself and with my team, especially my client service team. Because at the end of the day, we are here to take care of our patients and our clients. And if there's something that we can do that is better for that pet than the care we can provide, or different care that we can't provide for that pet, we should have no doubt in our mind to send them to someone even just down the street, right?
And so if that client is telling you, “I can't go to the emergency hospital for whatever reason,” but their pet is miserable, then I love that you said that because sometimes the answer should be, “Okay, I really feel strongly that this shouldn't wait. And so if you're not willing to do this, here's my suggestion.” Because you know what the alternative is? The alternative is they're going to go home and they're going to do what that customer would done, which is look it up herself, see that the Barnes & Noble down the street has it and go there anyways. So they're going to go home, they're going to Dr. Google and they're going to either find somebody else's care or they're going to try and treat things themselves. So it really matters to me that we keep in mind that we are in the customer service business at the end of the day.
And so I will tell you, there have been times where I've spent sent really good clients to our competition. Because here's the thing that I know, I know that if I take care of those clients, if I help them, they will on an overwhelming average comeback, even really good clients. And people are like, “Oh my God, but what if they have a better experience at that hospital? And what if we lose them as a client?”, then we weren't doing our jobs. If they could go for a one and done appointment and be so impressed by somebody else, that's okay. That teaches us some lessons about where we have opportunities as a practice. And if you're not willing to take those risks as a leader, I think you're selling yourself and your team short.

Andy Roark:
Yeah. Well, we create this inescapable trap for ourselves where it's like we are overwhelmed and we can't see all the pets. And also the idea of referring them to someone else is-

Stephanie Goss:
Yes, but nobody else can [inaudible 00:43:48].

Andy Roark:
… absolutely unacceptable. And they go, “Wait a second, you have 100% created this soul sucking trap that's burning you and your people out.” And I go, “This isn't worth it.' The other thing too is I would say let your purpose guide you. I have just found in life that if you have a purpose and that's what you follow, everything else seems to work itself out. You know what I mean? If you believe, I say, “I'm going to do what's best for pets,” and you set your prices appropriately, you will have a healthy business because you will take care of pets and make sure that the money makes sense and it works. But you can 100% focus not on the money, but on taking care of the pets and the money will take care of itself.
The same thing is true with this, is if you want to take care of the pets, at some point, that might mean I can't get these pets in and I'm sending them away, then you're going to sleep well at night knowing that you did what was best for pets and you're not going to burn out and quit and you'll be here years from now.
And so anyway, the idea that you would send people away because you're overwhelmed and then all of a sudden you can't get enough people to come in and support your business, I don't buy that. I don't believe that. I think that's a scarcity mentality and it's a recipe for disaster.

Stephanie Goss:
Yeah.

Andy Roark:
Hey, we are about 40 some minutes into this episode and I feel like this has all been really good head space, and I know a lot of people are really struggling with this. I don't want to sprint through the action steps. Are you okay Stephanie, what if we split this episode and then next week we'll come back and we'll just do action steps?

Stephanie Goss:
Yeah, let's do it. We're going to try something different, everybody. I love this because we've got some good action steps and I don't want to rush into these, Andy. Let's take our time and let's do it. So let's do our first two parter.

Andy Roark:
Our first two parter. Yeah, I think that's it. I'm looking at the action steps and stuff I have kind of laid out here that I want to unpack them. I think they're really helpful. So let's not rush. Let's just do head space right here. We're going to call this an episode.

Stephanie Goss:
Part one.

Andy Roark:
And then we'll see guys back next week and we will run through the rest of our action steps.

Stephanie Goss:
Stay tuned overwhelmed and won't give up because we'll be back.
Well, again, 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. I would really love to see more things like this come through the mail bag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mail bag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody and have a great week. We'll see you again next time.

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