This week on the podcast…
This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are deep in a conversation that was inspired by a recent discussion with a colleague about how to scale up the size of their practice when it feels like everyone else is paying WAY more than they are for associate veterinarian salaries. After a promising interview, one of our friends was highly disappointed when the associate candidate went somewhere else for a starting salary that was more than this practice owner pays themselves. Where do you even start with trying to grow when it feels like money is tight? Let's get into this…
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Episode Transcript
Stephanie Goss:
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Let's get into it.
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. This week on the podcast, Andy and I are tackling a conversation that was inspired by a discussion with a colleague of ours who is struggling after having interviewed what felt like a really promising associate veterinarian. Only to find out that they took a job at another practice that is offering significantly more money than they can. They're wondering how in the heck they get ahead when they couldn't even pay themselves what this new associate is earning elsewhere, and wondering how in the heck to start scaling up their practice. This was a really fun conversation. Let's get into it.
Speaker 2:
And now the Uncharted Podcast.
Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and the one and only Stephanie, Big Time, I'm on my way, I'm making it, Goss.
Stephanie Goss:
Can you please sing that song because I have no idea what-
Dr. Andy Roark:
You don't know Big Time? (Singing). You should listen to it. Peter Gabriel… First of all, you just dated yourself as younger than me.
Stephanie Goss:
No. But from your introduction, I was like, “I don't know actually what song he's referencing because-“
Dr. Andy Roark:
(Singing). It's such a weird song. I enjoy it. I like weird songs.
Stephanie Goss:
Also, because I like making you sing. How's it going Andy?
Dr. Andy Roark:
I am so not a good singer. It's good. It is good. Yeah. Cannot complain. Yeah, things are good. Summer's rolling along. Life is good. Staying busy. Yeah, I'm trying to think if there's anything else to tell you.
Stephanie Goss:
It is busy.
Dr. Andy Roark:
Yeah.
Stephanie Goss:
It's so busy right now.
Dr. Andy Roark:
It's just been a while. It's been, yeah, a wild summer.
Stephanie Goss:
So I have a question to ask you.
Dr. Andy Roark:
Yeah, sure.
Stephanie Goss:
I have been waiting. So you just got back from some time off? I need to know, was there a repeat of last year's beach chair saga when you went for beach week with your family?
Dr. Andy Roark:
I thought of you on the beach and I went and I sat my thing out and I remember the two people who came and sat right in front of me and no one did, which shows that I'm not crazy because last year I was like, “Boy, those people acted like I was the jerk” because they just came and sat right in front of me and my tent, between me and the beach and oh, they just came and put their chair. I was on a blissful beach by myself, no one else there. And these people came with their chairs and literally sat right in front of me between me and the beach. And when I said, “Hey, could you please move?” They acted like I was the biggest jerk. And so it was funny, I was sitting there in the sand looking in the beach and I a hundred percent thought of this story and I thought about you.
Stephanie Goss:
I've been waiting. I'm like, “Okay, Andy, this is the first day we've worked together since you have been back. And I'm just like, I can't leave to go on my vacation without knowing. Did we have a repeat of last year's beach saga?”
Dr. Andy Roark:
We did not. It seems like the moral fabric holding America together is actually holding up okay. I thought it was just totally coming apart.
Stephanie Goss:
Oh my gosh, that's so funny. So funny.
Dr. Andy Roark:
I will tell you this though. All right, so we're getting ready to go and the day before we leave, I got a call from the boarding facility, Noble Dog. The Noble Dog Hotel where Skipper Roark stays. And they were like, “We have to give you some news.” And I of course I'm freaking out whenever the boarding place called you the day before, you're like, “Oh no.” And they were like, “I just wanted you to know that Skipper is going to have to stay in the restricted playgroup.” And I said, “Why?” And as if I didn't know, I was like… And she was clearly uncomfortable. So this is the thing about me is when I know that someone is uncomfortable-
Stephanie Goss:
You've got to make them more uncomfortable.
Dr. Andy Roark:
I'm going to make it worse. Stephanie is like-
Stephanie Goss:
I know this from lots of experience.
Dr. Andy Roark:
And so she's like-
Stephanie Goss:
This poor girl.
Dr. Andy Roark:
Yes. So she's like Steph… Or she's like, “Skipper.” Stephanie also. Stephanie Goss also needs to be in the restricted playgroup, but for different reasons. Skipper Roark is in the restricted playgroup. And I said, “Why?” And she's like, “He's too.” And she's clearly struggling. She goes, “He's an aggressive humper, he's an aggressive humper.” And I was like, “Are you sure?” And she was like, “I'm afraid so.” And so I said, “Who's going to be in the restricted group?” And she's like “Big dogs.” And I was like, “Okay, but he's not going to be alone?” And she was like, “Oh no, no, there's going to be other dogs, but just not-“
Stephanie Goss:
He can't be with the little dogs.
Dr. Andy Roark:
Yes, he can't be with the little dogs.
Stephanie Goss:
Which is so funny because I had the dog that was the opposite to Skipper because I had the big dog that had to be with the little dogs because she was afraid of her own shadow and she was about a thousand times their size. But you would pick her up and she'd be out there with all the little micro chihuahuas and be happy as can be.
Dr. Andy Roark:
Oh yeah. No skipper's just annoying. He's just annoying. He's not bad, well, he's bad, but he's… Mostly, he's just annoy… He has no chill. He has no… You know when you take a dog to the dog park and they immediately get there and try to sniff everybody, that's Skipper. But it doesn't stop. The whole time he's in the dog park he is in that mode. He annoys me and he is not even sniffing me. So I take him there. And so I take him and I go to drop him off and she's like, “Yeah, as we said, he's in the restricted playgroup and I just need you to initial this sheet.”
And so she slides me the sheet and [inaudible 00:07:45] and on the sheet it says, they have all the little boarding parts all typed out and it says, “No Buster Zelensky on his sheet.” And I said, “What's a Buster Zelensky?” And she said, “Oh, he's another dog.” And I was like, “Oh.” And I said, “Buster doesn't get along with Skipper?” And she was like, “No, Buster particularly doesn't like Skipper.” And as I left for the beach, I left with the knowledge that there was a Buster Zelensky form somewhere that said, “No Skipper Roark” on it. And it made me happy. I was like-
Stephanie Goss:
So you have officially become that client?
Dr. Andy Roark:
Yeah, no, Buster Zelensky's owners dropped that dog off and they have to initial a thing that says “No Skipper.”
Stephanie Goss:
No Skipper Roark.
Dr. Andy Roark:
So anyway.
Stephanie Goss:
Oh my gosh. Skipper has reached a whole new level of bad dog.
Dr. Andy Roark:
I keep thinking he's going to mellow, but he's just not. And oh, Jacqueline was like, she's like, “I wonder if those guys would've traded Moose for Skipper” because Moose was the dog we met, when we were hiking. And I was like, “Boy, if they would do that deal, I'd fly him out here for him.” If it was a straight-up Moose, the golden retriever who I met for all of three minutes or Skipper Roark who I've had for five years going with Moose.
Stephanie Goss:
Poor Skipper.
Dr. Andy Roark:
[inaudible 00:09:16].
Stephanie Goss:
Okay.
I'm excited because we have been having a lot of conversation in the Uncharted community about growing practices and about finding new doctors. And I think everybody in veterinary medicine knows that we're facing a massive veterinarian shortage. And there's like, I don't know, I think the last study I saw, I feel like it was out of AVMA, but was like there's something like 18 open veterinarian positions for every one new graduate coming out of school. And so there's tons of jobs and not enough people and everybody's looking at how can they grow their practices and how can they be attractive, particularly smaller hospitals in an environment in vet med that is rapidly getting bigger in terms of corporates. And so I think there's this perception, I'm just going to say it up front. This is probably going to be an episode where Stephanie steps on a soapbox a few times. Because I think there's this perception of bet med that corporates have this magic money tree that they just shake and all the money falls out and they can pay veterinarians way more than the small guy.
And I know I've had this conversation with some of my friends and so we had one of our community members who was asking some questions and they were like, “I'm trying to grow my practice and I'm looking at this and I would like to have the discussion.” And you and I had gotten a letter in the mailbag at the same time from a clinic who was like, “Hey, I just recently interviewed a vet and I thought it went really, really well. We really connected. It seemed like a great cultural fit. So I made an offer and then I had a follow-up conversation and they were like, ‘I really loved you and I really loved the practice and I'm taking another job in the area because they offered me a schedule that was only working three days a week and for significantly more money. And so I really appreciate your time, but this is what I'm going to do.'”
And so the writer in the mailbag was saying, “I'm feeling really frustrated and I feel like I'm doing something wrong because I can't pay that much. And I know that there are things that I'll be able to do for my practice, for my patients, for my team if I grow the practice. How do I get bigger if I can't add doctors?” And that has been the conversation within our community is like, “How do we make that jump into the bigger pond from a one or two, one and a half doctor practice? How do we make that leap?” Because when you're that size, it feels insurmountable, the comparison between yourself and the big guys. And I just thought it was such a fun conversation and I am really looking forward to diving into this one with you.
Dr. Andy Roark:
Yeah, no, I like this a lot. I think this is good. Let's just start to roll into the head space here. So you're the practice owner, practice manager, team lead, whatever, where you're like, “This has just happened and I'm reacting to it.” The first thing that I want to say to people… I'm going to start off this by being annoying just so you know I'm going to be annoying-
Stephanie Goss:
You're going to be Skipper-
Dr. Andy Roark:
Because I'm-
Stephanie Goss:
Okay, let's do it.
Dr. Andy Roark:
No, I'm going to be that person who says things that you know are true, but you really don't want to hear it and it's just annoying. And I'm going to ask some questions that at first you're like, “Why would you ask that stupid question?” And then you're like, “Okay.” And I'm probably going to make it a bit more complicated than it feels like it should be. Because people generally come to us and they have this question and they're like, “How do I scale my practice?” And what they want us to say is, “Here, sell this widget that you didn't know existed.”
Stephanie Goss:
Here's the magic recipe.
Dr. Andy Roark:
“Add this service that you are unaware of and voila scaled practice.” And of course, of course it's not true. We're going to go into that first of all. So I'm just going to go ahead and give that annoying warning of this is going to be a little frustrating if you were like, “I've got my pen and paper. Tell me the thing to do to grow the revenue in my practice immediately.”
Stephanie Goss:
This is not that episode.
Dr. Andy Roark:
It's going to be a disappointment, yeah.
All right, so I'm going to start with a frustrating thing that people say, but I say it all the time. Comparison is the thief of joy. And here's what I mean before people go, “Wait a second, this is, what are we talking about?” Comparison is the thief of joy. Comparing your little independent practice to one of the thousands of practices owned by the Mars Corporation is a losing proposition. Especially if you let them frame up the comparison meaning, “I'm going to look at them and think about all the things they can do that I can't do or all the things they have that I don't have.” And I say, if that's how you're going to look at this, you are always going to be unhappy with the beautiful little practice that you built and that you run. You're just going to feel bad about yourself all the time because you're never going to have that level of resources. You're just not.
I had an article that came out in Today's Veterinary Business earlier this month. It came out in the June issue. And it was about the rulers we choose, meaning measuring rulers. We all pick how we define success. And so you got to be really careful about what rulers you choose to measure your practice. And so I know that's not what the person's writing about, but I just want to say it up front and say, if you compare yourself in the ways that the big corporations have huge advantages, you're always going to feel like you're failing or your practice is less than. But guys, that's not the only measure and that's not how most people see the world. It's really not.
The other thing I'll say that I have found that people don't like to hear this, it sucks, but it's not true, is it's not a fair game in a lot of ways. Meaning, my gut is that this is less common than it was, but for a while, a couple of years ago we had a lot of groups that were buying up practices and they had a lot of private equity money behind them and they were in growth mode. And so they just had these buckets of money that did not make sense and they were spending money that had no basis in business reality. And we heard horror stories about… it's not horror stories depending on who you are. And again, I'm not trying to knock the medical providers on the other side of this, but there were companies that were dropping money on doctor salaries, especially new graduate doctor salaries, and they were dropping these huge contracts on doctors and independent practices were looking and saying “That doctor is never going to produce enough money to justify what they're being paid by any realistic metric or measurement. How is this happening?”
And I think it affected me at the time because I've always been one who said, “The numbers have to make sense and we're all playing this game where the numbers have to make sense,” but when you have this investment money that's coming in, the numbers, at least in the short term, don't have to make sense. And so there were just things that were not… There was not a way that you could compete with them as far as dollars and what they were doing. Just it did not square up. Now, the good news is those birds always come home to roost. At some point the people who are spending that money, they're expecting a return on their investment and that is… So things are going to come back around, they're going to have to even out. And I think we're already seeing that. I think a lot of that stuff has started to mellow out a bit, but it still goes on.
And if you're a little independent practice, you just don't have private equity money that says “Get bigger, get bigger. I don't care what it costs.” You're just playing a different game. And so the first thing I would say is comparison is a thief of joy and it can be frustrating and you have the right to be frustrated and I think everybody would be frustrated. However, you need to think about why you got into this and you need to think about what is important to you about having a practice and why your practice is special and how you are going to measure success. Because if you measure success as a race against the Mars Company to earn profit, I'm like, “Buddy, you're taking a pocket knife into a nuclear arms race. You're not supposed to be here”
You're not doing anything wrong, but man, the way that we frame success in our minds is a big deal. And so we're talking about head space. Be kind to yourself, recognize where you're comparing yourself and just try to put that down and say, “Given that this is the landscape we live in, how am I going to be successful in the way that I want to be successful?” And that it's so much healthier and it will make you so much happier and you'll still have a good business, but you're not fighting an unwinnable battle.
And the worst thing that I see is small independent practices that have huge hearts and people on the ground that love the practice and want it to be special, giving up their love and the things that make their practice special to try to chase after someone who's not bad, they're just running an entirely different model and they're playing a different game from you. And so I've seen people give up the things that they love and that make them unique so that they could try to run after a massive corporation that's just playing the capitalism game. And that's not bad. But God, don't give up the magic. Don't be upset with your beautiful baby because it's not something totally different than what you made it to be.
Stephanie Goss:
I agree with you a hundred percent on the comparison piece. And I think the other piece of it is, for me is sitting back and asking yourself what do you actually want and why do you want it? I think you need to know what why is to drive yourself. But I ask, it's so often… To your point about playing the comparison game, so often I talk to independent practices and I'm like, “What is it that you want and what is being driven by should?” They think that they should be doing this. They think that this is the next step they should take, but there's not actually a why behind that. It's like, “I have one doctor and I want to retire and so I need another doctor”, okay, that makes sense. “Well, I have two doctors and I feel like the next step should be that I should get to three or four.” Why? What's the why there? Do you want a bigger practice? Do you want to employ more people? Do you want to get a bigger facility and in order to do that you need more? What is the why?
I think that for me, the head space starts with sitting back and looking at what are you trying to do and why are you trying to do it? Because you need to get really crystal clear. For me as a manager, the questions that I'm going to ask you have to do with numbers and sense. And if you don't know why you're trying to do what you are trying to do, you're not going to be able to answer any of my questions and you're not going to be able to solve this problem. And I think that that's the thing that I have seen time and time again. I've had conversations with practice owners and practice managers who are just like, “This is an unsolvable problem. I'm just going to give up because I can't compete.” And to your point, we're often competing with a should or a thing like competing with it, being a small practice, trying to look and measure yourself comparative to a giant corporation. That's not the right question to be asking yourself.
Dr. Andy Roark:
You're speaking to my soul. Man, the whole should game, it's so hard to get away from and it's a byproduct in some ways, I think, of access to information that we have now that we didn't use to. I don't know that most people running vet clinics pre-internet knew what other vet clinics were doing. They definitely were not bombarded with these continued messages about what it means to have a “successful practice.” They were just largely out there doing their thing. And I'm not convinced that that's so bad, really as long as you are happy and people would say, “But by having the best business practices hammered into us, we've made better practices financially.” And that is true and knowledge is power, but I think that there's that this is what you're supposed to do with your practice or this is what you're supposed to do with your career.
And so I want to expand it out because I've been seeing this a lot. There are messages about what a practice is supposed to look like and what the life of a practice is supposed to be, which is bigger, bigger, bigger. Or if you can't get bigger, multiples. If you not going to grow this practice, you need to have a second practice. And I go, “Who made that the case? Who said that's what should happen?” And it's been amazing, over the last five years, I have seen more people pushing back against that and saying, “I don't want to run a bigger practice. I want to run this practice with fewer headaches. I want to run this practice and just have it run more smoothly and simply. I'd like this practice to be more profitable, yes, but I don't want to manage seven doctors. I like managing two doctors plus myself and that's what I enjoy.”
Lifestyle business is not a dirty word. It shouldn't be. Some people say it is. I've felt that way as people are like, “Oh, a lifestyle business, that just means you didn't build something that could scale.” And it goes, “No, I strongly disagree with that.” It means you decided what you wanted to create and what was important to you and you made it, but boy, should is such a powerful thing. There's so many doctors that feel like they should move into management, but they don't want to move to management. But that's what you're supposed to do because it shows that you have your ish together and that's what you do.
And we see it even more in the paraprofessionals, which means you're a good tech, you should be the head tech. And you're the head tech and you're doing a good job, you should be the practice manager. And then if you're in a corporate structure, you should be a regional manager. And onward and upward and you go, “Why is that what should happen?” What if you don't want that? What if that's not what's interesting to you? But man, this is the march that should happen. That's such a powerful force.
And so I want to tag onto that as well. And so it's interesting, and I said I was going to be annoying at the beginning, but we get this question and it says, “How do I scale my business if I can't add DVMs?” That's the question. And so I push back on that and say, are you sure that you have the right outcome that you care about? Is financial growth generating more money…is that really what you want and care about? And so we talk a lot about root cause analysis. I would say, why is scaling important to you? And I don't know what they would say. I would guess they would say something like, “I want to be able to attract veterinarians that want to come so that we can handle the workload that we have.” And that's really important is “I want to attract enough people that I can serve my community.”
And then I would say, great, do you recognize now that scaling and generating more revenue is a way to attract more doctors, but really what you want is to attract more doctors. It's not to generate more revenue. The revenue is a means to an end and the end being “I want to be a place that people want to come and stay.” And so I hope that you see that I've already tried to cut loose the bonds that are around your hand and say, “This doesn't have to be about money.” Sure, let's see if we can get our practice to be a bit more profitable so that we can sweeten the pot, but ultimately we may never be just minting money. I'm confident there are other ways that we can find people who want to work with us. And I'm confident that we have other things that we can offer.
And I think you're going to have a much easier time digging into the culture that you have and what makes your practice special and trying to find people who match and who said, “Yes, this is where I want to be.” Then you are ratcheting up your income so that you can compete with the specialty hospital that's trying to hire emergency doctors or whatever. I think that those can be very different things.
Stephanie Goss:
The other thing too, I think that goes back to the why. Because to your point, if my why is I want to grow because I want to retire and I need somebody to take this place over or I need to be saleable, then I would say, “What does that look like to you? Are you talking about trying to retire in the next five years or are you talking about trying to retire 20 years from now?” Because the strategy that I apply to that why, if your why is to get out in the next five years. I'm going to look at that from a very different strategy perspective than a plan that involves a 20-year timeline. Because do you really need another doctor today if you want to get out in 20 years or is it worth finding the right doctor, to your point, who is someone who wants to be a part of the community, who wants to take care of those clients, who wants to take care of those patients? Can you wait to find the right fit? Or is the why requiring a different plan of action?
And so I think you can't figure out how to solve this problem until you know the answer to that question. So I love your idea of asking yourself the root cause analysis and asking the fivefold why. Why do I want to do this? Why do I want to do that? And trying to figure out what is it that you're actually trying to accomplish?
Dr. Andy Roark:
Yeah, that's exactly it. And in that same vein, one of the things that I've been thinking a lot about recently is that we tend to tell ourselves that there are outcomes that we need. And if we can achieve this outcome, everything will be fine. If I can just generate more money in our practice, then everything will be great. If I can just get this degree that I have been fantasizing about, then everything will be great. If I could just move to the West Coast, then life would be so much better and I would have what I wanted. Whatever those things are-
Stephanie Goss:
It would, by the way.
Dr. Andy Roark:
But we have those thoughts. And so what I've been thinking a lot about recently is this idea that generally outcomes do not make that much of a difference to us. And when we say… Meaning, and I always talk about there is no dragon, meaning I spent a lot of my life chasing outcomes, chasing dragons to slay, problems to solve, challenges to overcome. And what I found is there is no challenge that you overcome and it makes you whole or it makes you happy, or makes you know that you're successful or know that you're worthy. That dragon doesn't exist. There is no dragon. And so it's the same thing with all these outcomes. And I go, “Okay, I think that we convince ourselves if I can get this outcome, my problems will go away.”
And so the workaround here and what I found great power is I don't think we really want outcomes. I think that we imagine we are going to feel a certain way or have a certain experience if we achieve an outcome. If I get this degree, I will feel confident. If I move to the West Coast, I will feel like I have freedom. I'll feel like I have freedom, I'll be out from under whatever constraints I have here. But I will feel free if I move to the West Coast. If I generate this revenue, then I'll have security. If I had more money, I would feel safe. And so there's feelings that are tied to these outcomes and so keep walking with me.
If you can recognize that, oftentimes you can identify the emotion that you're trying to have, the feeling or experience you're trying to have. You can often just go ahead and do things to get that feeling without going through the whole process of getting whatever this big outcome is that you want. And so for example, if you say, “I desperately need our practice to generate $10 million a year in revenue,” and I would say, how do you think you're going to feel when your practice generates $10 million in revenue? And you said to me, “I'm going to feel safe. I'm going to know that I'm okay. I'm going to know that if hard times come, we are fine and I'll be great.”
Now, I could at this point say, “Just so you know, when you get $10 million, you're not going to feel safe because you're going to have to keep making $10 million to keep paying your staff and it never ends.” I told you I was going to be a jerk, but I would not say that to the person. Instead, I would just let that go and I would not say anything about it. And I would say, “What can you do right now to generate feelings of safety? Are there things that we can do that are not making $10 million that can still make us feel safe? Maybe that's having a plan, maybe that's looking at our insurance coverage. Maybe that's figuring out what plan B is going to be and just being okay with it. Maybe it's thinking through what the worst case scenario is. Maybe it's making a series of safety checks that are going to stop us from getting there. But what is that? What can we do now to give you that experience?
And so going to the person who said, “How do I scale when I can't add DVMs?” What I want to say is, how are you going to feel when you do “Scale”? How's that going to make you feel? Is that going to make you feel free because you can have more time off? Is that going to make you feel… Is it going to make you feel successful because you feel like you're taking care of your community? Is that going to make you feel safe because you feel like you're not going to have your employees boycott and quit on you? And now my friends, this is why I love this so much. I get excited about these exerciseS, but I really love this, because depending on what you said to me, I would give you different recommendations.
So if you said, “If I could scale, then I would feel free because I have time off,” I would say maybe the question is not how do I scale? Maybe the question is how do I get more freedom? How do I get more time off? Because you don't need to generate revenue necessarily to have time off. There's other things that we can do. If you said, “I want to serve my community,” I go, “Great, are there other ways besides generating revenue and getting bigger that we can serve our community?” So maybe we can get that experience, that thing we want without having to go through the financial part.
And then again, if it's a safety thing, I would say, “Hey, you're not going to believe this, but getting bigger and taking on more employees, it may not actually make you feel safer.”
Stephanie Goss:
It might be more scary.
Dr. Andy Roark:
It might be more scary when you get there. And again, but what are the things that we can do now to create that?
So anyway, again, I hope that's not too woo-woo or out there, but these are things that I really think a lot about and I just… They're ideas that I'm really excited about and I just have seen so much good come out of the idea of, all right, I see that you're striving… Because we have so many people who are in our profession and they're striving and they're striving and they're striving. And that question of how are you going to feel when you get there? Imagine you succeed, what's it going to get for you? How are you going to… What's that experience going to be? Man, that is a powerful tool to understand what makes people run. A lot of times people are like, “I won't be afraid anymore.” And I'm like, “I hate to tell you, but yeah, you will be.” And so let's figure out what we can do right here and now to not be driven by fear or whatever the thing is.
Stephanie Goss:
And I'm going to be vulnerable and share. So Andy did this exercise on me one time. This is where I thought you were going when you started talking about-
Dr. Andy Roark:
I don't remember this story. No, I'm [inaudible 00:33:43]. I have such a bad memory. It's great. I'm just like every day's a new journey when people tell me what we did yesterday. It's not that bad-
Stephanie Goss:
You and I were and I were together at a conference and we were sitting down and we were having conversation about development, because you mentioned school, you asked me about development and I was like, “I feel like I probably should consider getting my MBA” and the word should came up and you were just like, “Tell me more.” And I was just like, “Well,” and I had to sit there and think about it and it was really hard. And I was just like, “Well, this is… I like education, I like growing and developing myself and I feel like I've done the practical experience things and getting my MBA would continue to fle sh out my book learning education. And I feel like I could learn things outside of veterinary medicine that I could apply.” And I don't know what else I said, but you were like, “Okay, and what would you do with that?” So you were asking me these questions and I was sitting there and I was just like… It was real hard.
Dr. Andy Roark:
Yeah, I remember this conversation.
Stephanie Goss:
Was just like, “I don't know.” And ultimately we were sitting there and Andy made me cry, as he does. So I'm sitting there and I can't–
Dr. Andy Roark:
Not in a bad way, not in a bad… I just want to-
Stephanie Goss:
Not in a bad way, not in a bad way-
Dr. Andy Roark:
It was not a bad-
Stephanie Goss:
I started-
Dr. Andy Roark:
How dare you? Like no, it was not that.
Stephanie Goss:
Because I'm sitting there and I'm realizing, as Andy said, that a lot of it was tied up in feelings and emotions. And what I realized was that the reason why I said I thought my development goal should be to get my MBA had a lot to do with feelings and emotions. And I will tell you guys, I left that conference and I did not go sign up for an MBA. I took some of that money that I would've spent on getting my MBA. And I took myself to therapy and I started working on some of the feelings and the emotions and I actually started working with the coach and working on the feelings. Because for me, the should was motivated by personal feelings of imposter syndrome and that I didn't think that I measured up.
And for me, in my head, the story I had told myself was that if I have this piece of paper that I will be able to feel like I am qualified to be where I am and I will have letters behind my name that will make other people look at me in a different way. And what I realized through the course of the conversation was, oh, okay, A, I'm being driven by a should and that's not actually a good thing here. And also B, the why was important and I needed to do that work and dive into the feelings and do some self-work. And I think had I gone into an MBA program at that point in time, I don't think that I would have gotten out of it what I could get out of it if I went through a program like that. Now, because I had done the… I did a lot of hard work in between that conversation and where we are now. And so I think I would've had a different experience.
And so I am so glad that you talked about that and also recognizing that this is hard and this is a lot of hard work. And if you come by the answers to why very quickly when you sit down to do this, if Andy or I was in the room with you, we would both look at you and say, “That was too easy, start over, try harder.” Because the answer should not be quick and it should be hard. This should be a hard process, but the hard is worth it at the end. Because if you know your why, that's where you then can move yourself really comfortably into the action step part of this conversation. But from a manager perspective and a leadership support perspective, if you're not crystal clear as an owner on the why of why do I want to scale my practice, where am I trying to go? I can't help you. You could pay a consultant thousands, hundreds of thousands of dollars and they're still not going to be able to help you figure it out either. You have to know what that why is.
Dr. Andy Roark:
Yeah, I remember that conversation. It was a really good conversation and the way I remember it was, you said, “I want to do this MBA,” and I said, I went through the exercise with you and I was like, “Why is that important and what do you think is going to be different when you have this and things?” And so it was, it's funny because you felt like “I should do this, I need this, it's going to change the way that people look at me and blah-blah-blah.” And we talked about it and the way that I saw you from the outside, which was fascinating was that Uncharted was growing so fast and you were right in the middle of it. And I'm like, “Here's someone who's buried in opportunities. Our biggest problem is not, we don't have opportunities, we have too many opportunities.” And that was it.
And you were like, “I need more education.” And I'm like, “We are having people throwing work at us and we can't get done the stuff that we are getting. And it's good, we can't do all the things we're excited about right now.” And so going and getting something… And again, I'm saying this because I don't want people to think, “Oh, Andy and Stephanie don't like MBAs.” It's not that, but it was just like you were like, “People look at me differently” and I just see people with this adoration in their eyes. And you had just lectured to a room of 700 people. I was glad I wasn't in the program. Because I was like, “I don't want to hear from Goss how she had twice as many people in a room as me.”
Literally, I couldn't get into the room that you were lecturing in. And you're like, “Yeah, I think people will look at me differently if I had this MBA” and I'm like, “You're out of your mind. What are you talking about?” I hope it's okay for me to say that, but –
Stephanie Goss:
And then I started crying.
Dr. Andy Roark:
And that's when you cried and that's when you cried. It was much more of a fatherly Andy like “Hmm, let's think about this.” But ultimately that's where the conversation went. But it was that. But it was really fascinating. It was really fascinating as your friend to have the talk with you. But it was that thing of… To be honest, it's intimidating to go up and talk in front of all these people and you have these feelings of like “I'm supposed to have all the answers and I'm supposed to be able to fix. Every one of them should be able to throw their practice at me and I can fix it in the air.”
But we have those should expectations of, and again, the outcome is a great example “If I had this M B A, then I could do that and if I couldn't, I would feel okay, because I would still know that I knew my stuff” and I go, “I don't think that's true.” But anyway, thank you for sharing that. But yeah, it was… Yeah, I'll always remember that of, man, we've all got these should ideas. But anyway, I'm just a big believer in that. So anyway, that's my stuff.
As we start to look at, yeah, how do I scale the practice? I wanted to get all those things out. Of course I still want to answer the question of scaling and how can we drive revenue, but I really do want to think that just because of where this comes from, the last thing that I want to say, and this could go in the action steps, but I'm going to put it in head space real quick and then I'm going to be done. Is when you're the owner, when you're the medical director, when you're the manager and we start to have thoughts like this and we're like, “We need to scale so that we can attract doctors” and things like that, it is so easy to turn to your team and essentially say, “We need to make more money. I need you guys to make more money, let's make more money. Don't you understand that we have to make more money in order to be able to pay you guys? Guys, we're going to be in trouble if we don't make more money.”
And as the team leader, when you have that either internally, that push of “We need to scale so that we can grow so we can serve the community” or that comes down from above, you have got to be so careful because there are very few things that turn that teams off as much as someone turning to them and saying, “We have to make more money, don't you know.” Even if it's for them. And people go, “But I tell them, it's so I can pay you guys.” And I'm going, “I still find that to be hugely demotivational.” Because for a long time I thought, “If they know it's so their salaries can go up, they feel differently.” And I think there's something to that, but still, I think a lot of people overplay that. It's like a lot of your people are not there for the money and when you start talking about the money, they can immediately flip to a place of, “Oh, I see what's happened. This is all about the money. That's what this place is about.” Or “That's what this leader is about.” And boy, you lose credibility really fast.
It's a real culture clash in that medicine where a lot of people immediately get turned right off about that. And so you just have to be careful when you start to… That's another reason why I go through what are we really trying to do here? Because you have to be really careful about how we talk to our team about we need to make more money, we need to increase revenue. Because if you don't do a good job of communicating the why and getting them on board, you're going to really turn them off.
Stephanie Goss:
Do you want to take a quick break and then come back and talk some action steps?
Dr. Andy Roark:
Yeah, let's do it.
Stephanie Goss:
All right.
Hey friends. I want to make sure that you don't miss an opportunity to talk about topics like the one we talked about on the podcast today. That's right. In October, and October 11th to be precise, we are doing our fall virtual conference. This year, we're tackling culture and I cannot wait to dive into topics about accountability and creating a culture of accountability in our practices and how do we build trust and work together. And it is going to be so much fun. We have jam-packed a one-day schedule to make it not too difficult for you to get off the floor at the practice and participate. Even though it's virtual, we build a community and connections and love to talk to one another. So this is not your passive watch CE on a screen. We are going to be doing interactive workshops, interactive discussions. We've got our choose your own adventure format and I cannot wait to dive into it. So head over to the website at unchartedvet.com/events and sign up for our culture conference happening October 11th. See you there.
Dr. Andy Roark:
All right, so let's start to do our action steps. Big things that stress coming in. Opening language that I always like for things like this when we're about to make change, especially we're starting to pushing into revenue, things like that. Anywhere we're going to start changing the way that we work, I'm a big fan of going to the team and not saying, “Guys, we got to make changes. Guys, this is not working. We can't keep up with the other guys. We got to make changes.” That's scary and it's demotivational. The best way to go at this is to say, “Guys, I love our practice. We are doing great. You guys are doing great. I see and appreciate you and we are going to the next level. We are going to make some changes. I want to start empowering our paraprofessionals more. I want to grow what we're doing. I want to help more pet owners. Guys, we can do this.”
And you feel the difference in just those two approaches. I see a lot of times… And I get it, I a hundred percent get it. It's so easy to go and say, “Guys, I'm going to be honest with you.” And again, I'm not talking about lying to people, get me wrong, but oftentimes we can frame it as “This is not working, we need to do things differently” or “You guys are amazing and we're going to do things differently so we can continue to grow.” The second is much more positive and motivational. And I think if we can frame things in that light, people tend to get on board a lot faster.
Stephanie Goss:
Yeah, I would agree with that. And I think that goes back to if you know why you're doing what you're doing, it's really easy for you to frame that. What are we going to take to the next level? It's like we want to focus on efficiency and we want to focus… Because we want to be able to take care of more patients. The whole rest of that conversation comes so much easier when you know what that why is that's driving it.
Dr. Andy Roark:
Yeah, I completely agree. All right, so seeing that we're going to go down this road, we say how do we scale without doctors is a question, meaning how do we drive more revenue without more doctors? All right, cool. There's four levers that we can pull and usually the answer is not to pick one of these levers and pull it really hard. Usually the answer is to pick a couple of these levers, maybe start with one and do it and be gentle and pilot program and try it out and then pull a second one. And over the course of 6, 12, 18 months, start to make some adjustments here. But basically there's four levers in my mind. The first one is the price lever. It's the easiest one. Be careful. Definitely you can go to this too often, but the fastest path to success into cash or the fastest path to cash is increasing prices.
Whether you embrace them across the board or on the top 25 most common items, things like that. It's a quick way to generate revenue. Most practices have more upward mobility than they think they do. I understand why people don't like increasing prices. Of course, obviously there's a ceiling to this, but just as far as ease of implementation and straightforwardness, can you raise your prices? A straight price increase tends to generate a lot more revenue. And again, for people who don't think about this a lot, remember that when you run your business, you have a lot of fixed costs, you have a certain amount of money that is going to payroll and it's going to your hard costs. Beyond that, that money is profit that you can use to do things like hire other people and increase salaries.
And so if you increase your prices by 5%, you're not increasing your profits by 5%. You might be increasing your profits by 50% if you were only 5% profitable. And so anyway, it has an outsized impact on the bottom line, the money that you have at the end. So increasing prices is where you got to start. Do you agree?
Stephanie Goss:
Yeah, I do. And I love that. And what I would say is from a math perspective. When we got this question, my mind immediately dove into the math of getting another veterinarian. And in this conversation it was like, “Hey, this doctor took another job and they're working less days and making 40% more than I offered them.” Okay, I can work with that. Because if I take what I offered and I know what 40% more of that is, if that's my goal, if that doctor was like, “I loved you, but I'm going to work less days and make more money,” okay, I might not be able to solve the less days problem. Maybe I could, maybe I couldn't. But let's set that aside and let's just look at the money for a second.
If they need 40% more, how much more do I have to pay them? And so just using round numbers for the sake of ease. Let's say I offered a hundred thousand dollars. That's $40,000 more, that if I was paying them 40% more, so it's $140,000 instead of a hundred. So I take that difference and say, “Okay, what would I have to do now?” To your point, about that's not the number that you're going to use, but it gives me a starting place to say, “Okay, if I want to be able to offer $40,000 more, then I need to be able to generate four times more than that.” If I was a doctor and I was just saying, “I'm going to offer you this salary,” the rule of thumb is we want to pay them a cap of 25% of what they earn. So if I multiply that times four, I know what I have to generate minimally in revenue to cover that $40,000.
Now all of a sudden I have hard numbers that I can work with to your first lever, which is prices and say, “If I need to generate overall $300,000, again just round numbers, $300,000 more in a year to pay this vet $40,000 more or a vet $40,000 more. How do I make $300,000? Can I do that on a price increase alone. What would that look like? Is it taking the top 25 things and raising them $2? Is it raising prices on not shopped items by a hundred dollars? Is it some combination of those things?” Now you have an end goal that helps you look much more clearly and in a focused way at the raising prices.
And it isn't just this like “I guess maybe I'm going to do a 2% price increase and hope that it makes me enough money that someday down the road I can pay another vet the money that they're asking for.” No, stop that. Stop it right now, let's look at the numbers and say, if you wanted to hire this vet tomorrow and you're feeling like you couldn't afford to pay them the $140,000, what do you have to do to get there? And you have to look at it from that concrete numbers perspective. And so looking at those prices, it allows you to say, “Oh, okay, if I increase my fecals by $10, how much of that 40,000 am I going to generate just doing the same amount of fecals as I did last year, not doing more, just the same things that I've already done?” And you can look at it from that hard numbers perspective.
Dr. Andy Roark:
Yeah, I love it. I think the second lever for me is increasing efficiency. This is, with the staff that we have, how do we more work? So how do we scale without adding doctors, basically? How do we do more work? I don't want to get too far into this, because [inaudible 00:51:51] be a whole thing. I think we've got podcasts, I'm sure we do on increasing efficiency. But a lot of this is… There's a couple things. One is just where do we get faster without giving up the client experience? And so some of it is training. Can we train on dentistry so that we're getting patients down and getting dentals done faster and getting people out, we can get more dentals done in a day, we can look at our systems to move more quickly and get these things done? Is we can add services like texting or things to make the front desk more efficiency? In-room checkout? Whatever the things are. And again, your practice is going to need different things.
Look at what happens in your practices and look at where things bogged down. Where are people standing with leashes waiting for help? What are they doing from a staffing capacity as far as having people where they're needed? But all of these things, I can keep going on and on and on. A lot of it is looking how do we get faster at what we're doing? And so a lot of times it's training. It's looking at our repeatable processes, the things that we do again and again and again and again in our day and figuring out how to make them go 10% faster. And boy, that makes a huge difference when you're talking about something you do hundreds of times. So anyway, that's the stuff that I'm starting to look at. Can I use technology to take weight off of communications at front desk? Things like that.
Stephanie Goss:
Yeah, I love it. I love it because from a management perspective, that's going to be the first question I ask an owner doctor who says to me, “I want to hire another vet.” Have we actually maxed out on our efficiency and capacity, or do we need more paraprofessional staff or do we need better trained paraprofessional staff? Where can we do things faster and more efficiently? And if the answer to that is no, that's where we have to start.
Dr. Andy Roark:
Yeah, I love it. So that's lever number two. Lever number three is shifting focus towards the profitable services. If you make a bunch of profit on fecals, let's just say, I used that earlier, can we increase the number of fecals that we do? And so there's absolutely like, “Hey, this is parasiticide and parasite detection is something that is a big driver for us. Let's start talking about our fecal compliance. If it's a big driver for us and we're 55% compliant, can we get up to 65% compliant? What would that look like?” And there's lots of different ways to do that as far as education, as far as adding things like drop-off cups and thing… I'm a huge fan of doing stuff like that. There's lots of different ways that we can do that.
Dentistry. Is dentistry a big driver for you? Are you maxed out in how you're talking about dentistry and what you're doing to get dental compliance? Can we start doing dental callbacks that say, “Hey, your pet was in and was given a grade two of four dental disease score and you were in six weeks ago and so we wanted to call and check in and just say, ‘Hey, that's really important, do you want to go ahead and set that up?'” And just doing more things like that. I've seen programs like that that are extremely effective in getting people in. [inaudible 00:54:54] if dentistry is your jam and it's where you make revenue, can we get people in for that?
We got a new ultrasound and it's one of the swanky ones where we are able to send it out digitally to the radiographer or radiologist. And this is a revenue generator for us. Are the techs talking about ultrasound? Are we doing all the things we could be doing with it? Are we using it less than we could be? Are there wellness plans that we are not talking about? Can we get our wellness plan utilization up? And again, that's just shifting over and saying, “I know these things take time. Let's make sure that we're focusing on them.” I'm not talking about introducing new things.
But anyway, whatever the profitable services are for you, let's focus on those. It's funny, a lot of times I see people being like, “We've got to get people in here” and they'll get them in for a rabies vaccine. And I'm like, “That's a lot of effort for something that doesn't move the needle.” Again, good medicine, good for the pet, but if the goal is to get revenue up so that we can hire and get more help, let's be smart about what we're focusing on to make sure that we're growing the right parts of our business through awareness.
Stephanie Goss:
I love that. I agree with that. What's the fourth lever?
Dr. Andy Roark:
The fourth one is near and dear to both of our hearts. It's leverage your paraprofessionals. If you can't hire doctors and we need to get more profitable, we need to scale our business, it's time. It's time. It's time to look at our paraprofessionals and saying, “Are they working at the top of their license?” For me, are there products and services the paraprofessionals could deliver that we're not doing? If you're not doing tech appointments, man, that's a quick and easy way to start leveraging and scaling. It's amazing what techs can do. I have to throw out here and say you need to look at your state Practice Act because mileage may vary depending on the state. You need to pay attention to the regulations. So I can't just say, “Do these things” because it's different across the country. But you need to look at the Practice Act and figure out what can my paraprofessionals do that right now my doctors are doing and and how do we delegate to them?
So anyway, just think about that. Look at your state Practice Act, couple the state Practice Act with a training program, it's not okay to be like, “That's it. We're doing tech appointments. Go.” Let's figure out what a tech appointment looks like. Let's make a plan. Let's train for it so the staff feels good and knows what's expected. The clients are going to have a good experience. There's some legwork here, but let's start to do that.
The last thing I will throw out, I got to plug it. If you're like, “Hey, this sounds good, I'd be interested in having my techs jump in the rooms and do more stuff. And I don't really know how I would train them though.” I have an on-demand training program called the Exam Room Communication Toolkit. You can find it at drandyroark.com. It is 17 different tools for working in the exam room effectively. It is made for teams to take together. So it is great whether you're using your texts and appointments or whether you're thinking about doing it, getting the team, whether it's techs and doctors or just techs, getting them together and watching it and having discussions about it. And it's made to have discussion sections and things like that. It's really a hundred percent meant to be getting your people together to train on how you want to do it in your practice.
But man, again, I'm sure there's other research out there. I have not seen anything nearly as complete as this exam room training course. And so it's on demand. You can take it whenever you want, but that's over at drandyroark.com. And it is my best attempt at trying to help you train your staff to be effective talking to pet owners.
Stephanie Goss:
Yeah, I love it. You're right, this is the place that is near and dear to our heart. And I love that you mentioned using them at the top of their license because so often when I talk to other managers or practice owners and we get into the weeds and I ask them, “Tell me what your team is doing.” There are so many areas where the doctors are doing things that they don't have to do and in states that allow technicians to be utilized more. And so I think especially this tends to be the case in a small practice. And so I think that's a place where you have to start. And I think you're spot on, Andy, that if we say, “Okay, if driving revenue is really the why here, and we're trying to scale from a revenue perspective,” if you go through and you check all four of these boxes, there is really no reason why you shouldn't be able to pay someone an acceptable market rate salary and be paying yourself that first and foremost and then be paying someone else or multiple someone else's that as well.
And what I would say is that if you look at it and you're like, “I still can't afford to pay somebody,” something's wrong in the equation because the reality is we should be able to scale the practice by pulling on a combination of these four levers without having to add another veterinarian. And if we've pulled the four levers and we've maxed everything out, we should be able to afford it.
Dr. Andy Roark:
No, I agree. So anyway, that's what I got. Those are the four levers that I see. There may be some other things that people can nitpick and add in, and I'm sure there's a million different ways to do this. Anyway, just big picture, that's how I look at it start to make a plan about what's the low hanging fruit? It's amazing how often people be like, “We need to get revenue up. Let's start building another wing onto the hospital where we're going to offer physical therapy.” And I'm like, “There's a lot of low hanging fruit over here that we could just have if you just want.”
Stephanie Goss:
Let's start with fecals.
Dr. Andy Roark:
They're like “No, physical therapy building.” I'm like, “Okay.”
Stephanie Goss:
That's it. We're done.
Dr. Andy Roark:
That's it. We're done. That's it. That's all I got.
Stephanie Goss:
Have a great week, everybody.
Dr. Andy Roark:
I'll be in the restricted play area. I'll see you later.
Stephanie Goss:
Everybody, that's a wrap on another episode of the podcast. Thanks so much for spending your time with us. We truly enjoy spending part of our week with you. As always, Andy and I enjoyed getting into this topic.
I have a tiny little favor to ask, actually, two of them. One is, if you can go to wherever you source your podcast from and hit the review button and leave us a review. We love hearing your feedback and knowing what you think of the podcast. And number two, if you haven't already, hit the subscribe button.
Thanks so much for listening, guys. We'll see you soon.
