This week on the podcast…
This week on the Uncharted Podcast, Dr. Andy Roark and practice management geek Stephanie Goss are in the mailbag to take on a question from an associate vet working in a practice that offers wellness plans. This vet is NOT a fan and they share some of their concerns with us in their letter. They are wondering how it can possibly be good for vets to offer them when it directly impacts their ability to make their salary, being paid on production. There are some seriously valid concerns and yet both Stephanie and Andy have strong thoughts about how to get into headspace to help plan action steps as this vet to tackle their concerns openly and honestly with their practice. Let's get into this…
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Episode Transcript
Stephanie Goss (00:00):
Hey everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, we've got an excellent question from the mailbag. It comes to us from an associate vet who is asking two simple questions. Am I wrong here? And what they're asking am I wrong about is, is there a middle ground in a practice that offers wellness plans where the associates, the pet owners, the patients, and the doctors who are paid on production all find a middle ground when it comes to wellness plans because this associate is not on board the wellness plan train. I am definitely on the wellness plan train. I think Andy could go either way, but either way, we had a lot of fun hashing this out. Let's get into this one, shall we?
Meg (00:55):
And now the Uncharted Podcast.
Dr. Andy Roark (01:02):
And we are back. It's me, Dr. Andy Roark and the one and only. Are you ready? Yep. I mean, nope, Goss.
Stephanie Goss (01:14):
It's that kind of day. Listen.
Dr. Andy Roark (01:17):
Oh yeah.
Stephanie Goss (01:17):
There's nothing I can do about it.
Dr. Andy Roark (01:19):
Oh, we've all been that way. But it's just awesome to watch you doing it. When I look at you and go, are you ready? And you say, yeah, wait, no.
Stephanie Goss (01:28):
You got to push the button.
Dr. Andy Roark (01:30):
It's going to be that kind of podcast. Like, oh, this is what we tuned in for. This is They'll get there. They'll get there.
Stephanie Goss (01:37):
Yeah. Today's going to be a fun one.
Dr. Andy Roark (01:41):
I wonder how, wonder how much our audience roots for us. I wonder how many people are like, get it together guys. Andy, you can just pull it together. Andy.
Stephanie Goss (01:51):
Get back on the rails. Well, this one has the potential to go off the rails just because we've been together a lot in the last week. Yes, yes. And I think it's funny because you said something to me yesterday that someone else who knows both of us said to me last week, which just made me laugh, which is we've been working together long enough now and we know each other both really, really well, and we can read each other really, really well. And there definitely are days where you feel like for better or for worse, functional or dysfunctional, you feel like the old married couple.
Dr. Andy Roark (02:32):
Oh yeah.
Stephanie Goss (02:34):
And I think this is one of those episodes because we were together all last week in Greenville because we just had our Uncharted April conference and it's coming off of that. We're both, I think, a little feeling really good and rejuvenated, but also a little punchy and tired.
Dr. Andy Roark (02:55):
Yeah. Oh yeah. That's funny. I've always felt sorry for Maria Pirita who works with the two of us. And so poor Maria last year comes in and joins Uncharted to help out me and Stephanie, and she's brilliant and wonderful and I just didn't realize how much you and I communicate in grunts. We make one-word statements and we're like, oh. And she's like, I'm sorry, did we just make a decision? It sounds like we made a decision, but I have no idea what happened. I'm like, [mumbles]
Stephanie Goss (03:28):
It's totally true. We can look at each other and read each other's body language and expressions and also have half sentences and know exactly where the other is going, and then move on from that thought to a completely different thought because we understood what the other was thinking. And so yes, there's a lot of sympathy for Maria.
Dr. Andy Roark (03:49):
I just remember one time a question came up and I said, okay. And Maria was like, great. Andy's on board. And you were like, Andy's not on board. That was a strong no from Andy. And I just remember her looking at us, like what?
Stephanie Goss (04:05):
What did I miss?
Dr. Andy Roark (04:07):
You said, okay. And I was like, yeah, but I said, okay, like
Stephanie Goss (04:15):
A hundred percent. We've had lots of conversations over this last year of You'll get there, you'll get there. Don't worry. You too in time will be able to read the Okays that Andy gives.
Dr. Andy Roark (04:33):
Yeah, that's totally true.
Stephanie Goss (04:35):
It's like a kid knowing that when their parent says maybe that doesn't actually mean maybe. That's exactly it.
Dr. Andy Roark (04:40):
That's exactly it. I was like, dad said, “maybe” that means no.
Stephanie Goss (04:43):
That means no. Oh, man. How are you doing?
Dr. Andy Roark (04:50):
I'm good. I'm super good. I think the Uncharted hangover is real. Yes. As we say, it's a beautiful thing. It's this feeling of awe. If you've never been Uncharted, it's, it's super special. It is not like other conferences. It's like summer camp. If you did summer camp as a kid and when it ended and you were like, I made all these new friends and I can't go out. It's like summer camp. But instead of archery and horseback riding and canoeing; we have motivating employees that don't want to be motivated, we have HR, we have these business development communication things, but the feeling of summer camp is still there. And so when people leave, they're like, I've got all these things I'm excited about and I've learned so, so much. And also I miss being with my friends terribly. And so there's about a one-day letdown that follows the conference. So I've been living through that for the last three days.
Stephanie Goss (05:55):
Yes, me too. And I will say that this conference felt, it was one of those ones where the conversation immediately picked up in the online community and we had a session. It actually had nothing to do with the, really with the actual workshop, but our friend Dr. Adam Little was speaking and he did a session and of course he's a super technology geek, and I love talking tech with Adam, but he was talking about some technology tools in your practice as a side note to his workshop. And they started talking a lot about Chat GPT and artificial intelligence. And you just recently did a podcast about that, right? With our friend Brandon Breshears. And so, I have been really excited to listen to that and kind of dive into it. I had signed up for it, but I hadn't really done a whole lot with it.
(06:52):
Well, Adam opened the doors and it was like the whole Uncharted community stepped through it this last week. And then Ron Sosa and Ben Spinks and some of the other community members who are super tech nerds, really got in on the conversation and started teaching people how to use it. And literally a bunch of people sat there and signed up for it and practiced with it. And it has been so fun to see what the community is doing with it the last three days in their practice, literally multiple times a day there have been posts in the community like, “Hey, I just used it to make these discharge instructions about how to bring in urine samples for a client.” or, “I just wrote this when somebody declines this test.” And it has been so fun for me. And so mind-blowing, I guess, because I just thought veterinary medicine is not technologically inclined. Where is this going? But it has been so fun to see what the community is doing with it.
Dr. Andy Roark (07:51):
Yeah, I agree that I was surprised by how much artificial intelligence came into the conference. Yes, it was, was on the agenda, but not a lot. And then it just really, as people started to use it at the conference, which again, I love that our conference is workshop based because people start doing the things. All of a sudden people are like, I know how to do this. And then they were feeding on different ideas of what they could use AI for and how to make their lives easier. And now, it's just snowballing in the online community. It's a beautiful thing.
Stephanie Goss (08:19):
And let's be real, we made up some sea shanties and some pirate songs and we messed with it. I think you could use Chat GPT to come up with nicknames for me for the podcast.
Dr. Andy Roark (08:30):
Oh, that's funny. I'll have to give that a try. I've done tons. I've not thought of that,
Stephanie Goss (08:35):
I would be curious to see if it can come up with a better bio than you because you make the best bios ever for people.
Dr. Andy Roark (08:40):
Well thank you. I appreciate that.
Stephanie Goss (08:42):
Anyways, we're off the rails already.
Dr. Andy Roark (08:45):
Yeah, this has nothing. This is a great conversation. This has nothing to do with what we're doing,
Stephanie Goss (08:50):
But we, it kind of does because Adam's workshop at Uncharted was talking a little bit about patient care for our own team members. And one of the pieces of the conversation was wellness plans. And we got a mail bag letter from a practice associate DVM in a practice whose practice has wellness plans. And they were saying that the practice has a goal to get at least a quarter of their clients on wellness plans. And they said, I understand the benefit for wellness plans to the clients, and I actually understand somewhat the benefits to the practice owner from a business perspective. But I feel like wellness plans are actually detrimental to the associate doctors because the doctors in the practice are being paid on production and the setup for their wellness plans sounds like they are maybe pretty significantly discounted from their regular prices.
(09:49):
And so they were saying that on the days when their technician happens to be the person who's also the wellness plan coordinator for that day, they've been struggling to make their revenue benchmarks for their overall patient charges for any patients that are seen that day. And so they were just like, I feel like I cannot get on the wellness plans bandwagon. And everybody has been trying to talk to me about it and talk about the good, talking about being able to see more patients, take care of more clients, that they're going to come back to us when they're sick, et cetera. But they were just really struggling. Cause I feel like our schedule is already full with patients, whether they're sick or well, and this is something that I feel like I'm not getting paid for and I don't feel on board. And they were asking two questions. One, am I wrong? Am I the jerk here? And two, is there a middle ground where both associates in the practice who are getting paid on production, the practice owner and the client are all going to be satisfied with offering wellness plans in the practice?
Dr. Andy Roark (10:59):
Yeah. I thought this is a great question and I love that it comes from the doctor who's like, I don't know about getting on board with this. I really like this. And so I have strong feelings. I have strong feelings. All right. Let's go ahead and start with Headspace as we do. And the first thing I want to do is, the question was, am I wrong about getting on board with this? And I will just tell you, there's no way around the idea, that the devil is in the details. When you start looking at associate vets and wellness plans and compensation. I think we've talked in the past a pretty good amount about the difference in production based compensation and salary for veterinarians and said, I'm fairly agnostic. I can go either way.
(11:47):
And I think there's good pros and cons for having doctors on salary versus having doctors on production. The truth about having doctors on production is it's a game. It's a game, and everybody's going to look at the game and they're going to be like, you're changing the rules of the game. And I am very skeptical that I am going to do as well under the new rules as I did on the old rules. And so the devil is in the details because I have seen people do some shady stuff with wellness plans as far as hiding revenue from the doctors and things like that where it's like, oh, we're going to go to a wellness plan and then you're not going to get compensated for all the other work you do after the initial sales and sort of things like that. And again, I don't mean to throw that out as the bite as an example of how these things are bad.
(12:36):
It's just the devil really is in the details. And you can make these very fair for doctors and you can also make 'em really crappy for doctors. And in a place where the vets take a big hit to their income and they're not going to be excited about it and they're not going to get on board with it. Ultimately the truth is going to come out. It's not going to be a surprise at the end, but the devil really is in the details where you say, should I get on board with this wellness plan that's now being offered in my practice? I go, I have no idea. I don't know. I don't what's in it. I don't know how it's broken out. I think you need to look at it and we'll come back of how you do that. But the devil's in the details.
(13:13):
The other thing I really want to do is just validate the scenery for the associate vets who are looking at this, the switch from having a straight up traditional model of care to a model of care that's based largely or almost entirely on wellness plans. It's massive. It's not like, oh, let's tinker with something. It's a different game. It literally is the difference in a classic, here's a product and you pay for it to a subscription model where it's like, you're going to pay this fee. And there's this weird thing about are you going to come back and get your services? Are you not? What does that mean? Do you pay monthly, blah, blah, blah. And it's a whole different model of what you're selling and what you're putting out. And so just the idea that people are going to be like, sure, let's just radically change the way we do business from a product on demand to a subscription service. That's a huge, huge jump. And so I don't know. I just want to say up front, I can't imagine somebody not having serious apprehension about making the jump if that's asking 'em to make this change.
Stephanie Goss (14:22):
And I think that from a Headspace perspective, the other piece of validating that from the devil being in the details perspective is that the mistake that I have seen a lot of practice leaders make, whether it's practice owners or practice managers or medical directors or some combination when they are introducing the idea of wellness plans in their practice, instead of starting with the why. Why are we actually doing this? What are our goals? Which it sounds like this practice has goals, but I would say if the whole team doesn't understand why you're doing what you're doing, the what becomes even more scary and a place where people either don't ask enough questions or ask what seems like too many questions and obsess over those details. And so I think that one of the pieces that is really important, like you said, is the understanding why you're doing what you're doing and what you're doing, because the perception about wellness plans can be very negative.
(15:32):
There can absolutely be a perception that you're just trying to offer low cost care to get clients in the door. And, I'll talk about it when we get to action steps in and later, but I am a huge proponent for wellness plans. We had them in my practice, and I will tell you that the doctors in my practice were involved in the creation of the plans, and it was no different than our regular standard of care. It for us. It simply was exactly what you just said, Andy, which is a way for pet owners to have a subscription model and spread out the cost of cares, right? And so there is a lot that needs to be understood from the philosophical perspective and then also the practical perspective. And I think it's really important as a leader that part of your implementation plan has to include covering that what and that why.
Dr. Andy Roark (16:26):
Yeah, they're not a panacea. Let's just go ahead and lay that up front, not this end of all your problems sort of thing. And so I think it's important to say that. When you go to wellness plans, you're going to have some headaches you didn't have in your old model. And that is explaining the benefits of the program, explaining what's not in the program. Dealing with the fact that people don't remember what the benefits of the program were or what was not in the program. Dealing with frustrated people who have a plan, but the plan does not cover the GDV surgery that their pet needs, nor did it ever include that, nor would it ever include that. That's just the ongoing community. You're going to have those headaches. It's just part of dealing with human beings. So it's not perfect.
(17:15):
I think my big things for wellness plans, this is why I am such a big fan, is we know that the average pet owner does not have enough money to go to the veterinarian's office based on what we currently charge. Most people spending more than $200 at a visit to the vet is a significant hardship. And a lot of our practices are hitting $200 visits every single time, basically. You know what I mean? Especially if you start putting parasiticides and things like that, heartworm, flea and tick, those sorts of things. Like you guys know that we go we way over that. And that's just not easy for a lot of people. And so that's part one is a lot of people just don't have a chunk of money to take one or two pets to the practice and just pick up a big tab.
(17:59):
And that's not just vet medicine, look at the world. Everything is going to a subscription model. It's kind of ridiculous how much we do as far as subscriptions, and maybe it's a generational thing, maybe it's just a, I don't know, ease of transactions or those sorts of things. But man, everything seems to be shifting over to monthly payments and it's how people do business and it's how they budget and how they pay for things except the vet that comes in at 350 bucks for your annual visit. And so I think part of it is just looking at the world and how it's changing and saying, how do we keep this affordable? And people will tell you all the time, they're not secretive about it. They're like, break this thing up into payments. And so the wellness plan is basically a move in that direction. It's trying to take good pet care and turn it into a subscription, which it just makes a lot of sense.
(18:51):
And again, the devil's in the detail in how you do it. So I agree with you start with why has got to be the first thing, get help the staff understand what we're doing and why we're doing it and how it really helps the pets. And it sounds like based on what we got in the mail bag that's kind of been done as far as explaining why this is good for pet owners and things like that. It's funny, I think a lot of times when we're talking about driving change in practices, why is this good for the pets? Why is it good for the clients? Why is it good for our team? And at some point you have to say, why is it good for the individuals? And those are different conversations we have at different times. But I do think for a lot of things, especially if you're asking for a big jump in behavior, a big change, we do have to unpack why is this good for them?
(19:35):
And it sounds like the practice is maybe done a pretty good job of talking about why it's good for the pet owners and why it's good for the practice, but they came up short in talking to the associates about, Hey, this makes some sense for you. And so that's really, I guess where I want to sort of start to focus our time. Sound good? I think whenever we talk about big change, and I got really into this at the Uncharted conference last week, what does done look like I think is a really good starting point is what does this actually look like when we're doing it? And I don't think anybody probably did that with our associate that's writing in. And so I want to lay down from the perspective of an associate what a really good wellness system looks like and feels like as the doctor.
(20:22):
Okay. So just imagine, again, this is, say we've got a plan that works well and the compensation is set up fairly and all of those sorts of things, but let's just talk about what it does. Okay? We've got a system where as a doctor, you can look at your schedule and know exactly what you're walking into when you have your wellness rooms. So you have your day and you're looking at your schedule, and right now you're looking at your schedule and you have no idea what's in any of those rooms. This could be in as a cough, but actually it's a wellness visit or it's in as a wellness and there's a million things wrong with it and all of these sorts of things. The first thing that happens in your schedule is it gets a lot more clear. Is this a sick visit where I'm going to go in and kind of roll the dice and see what I get?
(21:14):
Or is this a wellness visit where I know exactly what the expectations are? We know exactly what scheduled, exactly what these people are doing. Bam. There's a beautiful clarity that comes with having some of these blocks on your schedule where you go, I do not expect wild deviations here. So first thing is you can look, and I was talking to one of my friends who works in a practice that heavily uses wellness plans, and she was like, these can be more financially lucrative than sick visits when you don't know what you're going to get or if the people have resources to take care of their pets. And it can be a mentally resting day because you tend to be able to look and say, ah-ha, I know what I'm supposed to do. And so I really love that she talked about that. You can leverage your support staff like crazy on these appointments.
(22:00):
Yes. Right? Yes. Because there's a prescriptive thing. Yes, we know what they're doing. We know what they're in for, man, delegate, delegate, leverage, leverage. And now you're kicking butt with your support staff in a way you can't, when you're like, I don't know what this is, I don't know what they're going to do. I don't know what's expected and blah, blah, blah. So first thing is you can leverage your staff. The second thing is that you are able to roll in and do faster, less stressful exams with guaranteed outcomes because imagine what you're supposed to do. It's already been decided. It's already been dictated. You don't have to do the sales job. You don't have to go in and talk to 'em about what they're able to do, prioritize what's important or blah, blah, blah. It's all been agreed to. It's all been paid for. It's already done.
(22:43):
And it's just amazing. One, how that affects communication, how much faster that lets you go. And then also just to focus on giving the person a good experience. They've already paid for this experience, so they're not focused on what's this going to cost and blah, blah, blah. They're just getting the work done. And the final part of this, I'll start to lay down is that, and this is just bonkers, but it is human psychology, is that people do not come into these appointments and then add together what they've previously paid with what they're paying now. It's like when people go into the doctor and they're like, I paid $10 copay. It's like you paid $300 this month for health insurance and a $10 copay, but they don't see that. Or Oh, they're like, man, that was $10. So cheap. People are just that way, which means when you go into these visits and you've got everything laid out for wellness care and you just bang, bang, bang, and you knock it out and then you find an ear infection, boy, how much easier of a conversation to have to say, when you clean this ear, when need to cytology and we need to treat it, or even we talk about doing an ear culture.
(23:50):
Sure. They look at this and we're doing an ear culture and ear cytology and the bill's 200 bucks. Well, it's 200 bucks because all your vaccines are not in there because your preventatives, whatever, all that stuff is paid for.
Stephanie Goss (24:01):
Yep. That 200 has been taken out of it.
Dr. Andy Roark (24:04):
Yeah. Well, first is, if you didn't have the wellness plan, you go in there and they need parasiticide, heartworm, flea, tick, they need a fecal test, they need a heartworm test, they need blah, blah, blah, and there's an ear infection. Now they're looking at a $500 bill and they're going, there is no way we're doing this. It makes our jobs easier and better, and when they have to pay for additional things, it's not such a big deal because they're not also paying for the base care that they came in for right now, and they just don't think about it that way.
Stephanie Goss (24:34):
Yes.
Dr. Andy Roark (24:35):
And so that, that's it. And if you think about it, so that's just sort of a stress approach. So when this works well, you know more what your day is going to be like. You can leverage your staff better. You can get in there and have them just help you knock things out. And they know what's expected. You're not talking about money all the time. You're getting in there, you're just doing the care. You're doing the warm-fuzzy relationship part, and the person's leaving without getting their wallet out and they feel great about it. And then when you do find something, there's more chance that they're going to say yes, because hey, we got an ear infection. It's going to be 120 bucks to treat it when we do cytology and medications and blah, blah, blah. And they go, 120 bucks is okay, as opposed to me dropping it on top of your full wellness exam and making it 380 bucks, they're going to say yes.
(25:21):
And so that's when I go back to my friend, the associate vet who wrote in and say, look at this with me. You've, you've got more stability in your schedule. You've got more clarity about what's happening. You've got it set up so that you can lean on your support staff to rock and roll more smoothly. And then when you find other issues, you are more likely to get the green light to do good care, which is good for the pet owner. And I don't mean to be gosh, but you're going to get paid for that work that you would not otherwise be able to do when you break it up like this, you're a whole lot more likely to be able to do the urine culture you want to do or the ear culture that you want to do or to do topicals as well as oral antibiotics for the skin infection, which we know we should do. Yes. But sometimes people are looking at their wallet and they go, I can't do all these things. Yeah. Well, they're more likely to look at their wallet, have the same amount of money in their wallet that day and say, I can do all of this. And so ultimately it can be more lucrative for the doctor.
Stephanie Goss (26:24):
And I think your point about knowing what you're getting into from a wellness perspective is really important. And the other piece of it from headspace and a “why?” perspective that I think as a leader is very important to talk through, not only with your doctors but with your team, is it allows you significantly more reliability when it comes to the sick appointments. Because what you just talked about the getting to yes, with those sick appointments who are on wellness plans, whether they get a significant discount on continued care outside of their wellness plan or not, that point is moot because of the psychology that you were just talking about. So now instead of having an appointment book that is jammed full of sick patients and you have no idea whether people are going to say yes or no to the appointments, now you can start to look at your sick patients from the ease of getting to “Yes.”
(27:23):
Because statistically, we have shown as an industry the significant psychological impact that it has on our clients. The clients have told us there have been multiple studies from the lifetime of care studies to the numbers that come out from some of our corporate industry partners who do wellness plans all day long that show the significant increase, sometimes three and four times the normal amount that a client would spend on a visit when they are on a wellness plan because they're able to split it up and they're just doing it unconsciously in their head because they're not thinking to your point about that money that they already spent. And so when you're talking about the wellness plans, we tend to focus on the wellness care, and I understand where this associate vet is coming from because we have wellness appointments and puppies and kittens coming out our ears after covid, and nobody wants more wellness appointments on their schedule.
(28:16):
And I hear that and I get it. And it provides stability when it comes to those sick patients as well, because it allows us to plan for those things and have the easier conversations with the owner, particularly when we're talking about wellness plans that might build in some annual blood work or whatever. Then if you have a pet that's sick, you have the opportunity to use some of those plan benefits in a kind of an outside the box way that might benefit the patient. It makes getting to that sick pet to a yes a lot easier. And that's a step that I think a lot of us miss when we're setting up the why with our team. Yeah. It's not just about wellness. It's not just about puppies and kittens. It's not just about making sure that they all get spayed and neutered because we're offering it in a nice package with a bow around it. It really is about spreading out those payments to help more patients get more care that they actually need. And especially if you're approaching it from the place of your individual practice's standard of care, you're just allowing those clients to have access to that care that you would be recommending anyways. And so I think it's a headspace piece for sure that a lot of us miss when we are setting that up with our team and talking about the why.
Dr. Andy Roark (29:31):
And I just want to emphasize, again, I'm putting this forward as a blissful representation of wellness. I don't want anybody who has wellness plans to be like, boy, it's not like that for me every day. It's like, no, I get it. I said this. I wanted to put forward what done looks like. Meaning, when this is in place and everything has been adjusted and it works really well, where are we trying to get to? Because if you don't understand what done would look like or what the aspiration is, it can be challenging to get started. And also you don't exactly know where you're going. I want to sort of jump in and piggyback off of what you said as far as the wellness appointments and people don't want more wellness appointments on their schedule. Again, when this is set up and it runs really well, boy, those wellness appointments are your bread and butter.
(30:21):
You just count 'em, they're already paid for. You just got to go in and do the thing you've already agreed to do. Smile, shake hands, be friends. And man, it's easy to be friends with people when they don't have to get their wallet out that really makes it, and honestly, it makes it more enjoyable. Sure. You get to feel like the great doctor that's practicing when money's not a thing and that's aspirational. I think that that's really, that's really great. I just think it helps us all feel much better about what we're doing. The other thing that I would put forward too is this, and I talk a lot about this in the exam room and exam room communication, being able to be a master communicator and really educate and get a client on board with you, that doesn't make you a great vet.
(31:11):
What makes you a great vet is being able to get pet owner after pet owner after pet owner, after pet owner on board with you. I know a lot of vets who can be amazing and once every other day they decide to walk into an exam room and be amazing, but the rest of the time they just don't because it's hard to put on the show and get people on board over and over and over again. And I'm just being really, really honest here. It is hard to get up yet again to go in and talk to these people who don't want heartworm preventive about the fact that they need heartworm preventive. To talk to these people with this overweight pet again and again and again and again and just say, here's another one. I got to get up and go have this hard conversation.
(32:01):
And it's not so much having the hard conversation with a pet owner. It's the grind of having X number of appointments a day and trying to get up to be persuasive, advocate effectively for the pet again and again and again. And so one of the other things that I think, and again, I can't back this up with the research, lemme just say that I can't, this is just my perception. You guys can feel your gut and see if you agree with me in what I'm saying, but if I can get wellness plans locked in so that people are coming in and they're already agreed to what we're going to do, then that lets me save my emotional energy until I need to have that conversation and I need to be persuasive and I need to advocate because once I got on the plan, the advocacy for wellness care is already done, and that lets me just keep it in the gas tank so that when the person comes in at the end of the day, I can lean forward and have that conversation and put that effort into being persuasive into being a strong advocate because I haven't been a persuasive strong advocate all day long.
Stephanie Goss (33:04):
Right, right. Yeah. Oh, well, do you have any other Headspace thoughts?
Dr. Andy Roark (33:12):
No, I think that that's it. I, again, I think that starting off the devil's in the details, know that upfront and own it. This is always scary. It's always going to be scary, especially when people are paid on production because basically you are not changing the rules of the game. You are asking them to play a different game and trust you that it's going to work out for them. And that's a big jump and just know why it's there. I think your point of start with why is excellent, and then I just always say, what does done look like? Let's start with the end in mind. And I really tried to frame this hard. I don't want people to think that this is how I think a wellness plan is necessarily, but I really wanted to frame it up very much for our writer, the associate veterinarian who's thinking what's in this for me? Sure. That that's kind of how I want to set this up. So that's really the head space. And then I think, let's take a break and in our action steps, I think what I'd like to do is try to give our writer some action steps on how to navigate where we are going forward.
Stephanie Goss (34:11):
I love that because I've definitely got some ideas about how to have the conversation even midway through the process like this associate is with their management to understand those details because I think you're spot on with the devil being in the details, and I would love to talk about some of the things to ask to help yourself understand.
Dr. Andy Roark (34:31):
Sounds great.
Stephanie Goss (34:34):
Hey everybody, it's Stephanie, and I'm going to jump in here real quick for one second to make sure you know where to find out all about the things that are coming up at Uncharted. Now, Andy and I started out this episode. We were talking a lot about chatGPT and AI and some of the super nerdiness that happened at the recent Uncharted Veterinary Conference when we were in Greenville in April. And unfortunately for you, this episode is airing on May 24th. And you know what happened today? My friend Jen Quammen did a workshop for our Uncharted community and for you about using AI in practice. And when we first started talking about doing this workshop, I kind of thought it was a little nuts because I thought veterinary medicine does not adapt to technology. We are not tech savvy by and large, and really are we going to have the AI conversation?
(35:22):
And let me tell you, my mind was blown about the possibilities of how you can use this in your practice. I saw my colleagues and myself dive into trying it with some encouragement from our friend, Dr. Adam Little at Uncharted, and oh my gosh, I have used it literally every single day since I have come home to do something to help make my life run smoother. It is awesome. So unfortunately for you, you missed that workshop today, but you can still head over to unchartedvet.com/events and check out what is coming up so that you are not in this position again, where you are finding yourself sad because you missed another amazing workshop because we have got all kinds of stuff coming at you in the back half of the year. So head over to the website and check it out. And now back to the podcast.
Dr. Andy Roark (36:12):
All right, well, let's jump back into our action steps here. Okay. Sound good? All right, cool. So is, okay, so let me frame up where I see our position as an associate vet. It sounds like this is a change that is happening or has already happened, and so I don't know that even if we wanted to, we could dig our heels in and shut this down. It seems like this is going to be something that is, it's going to happen. The volcano is erupting, right? We can try to dig our heels in and we're probably going to get run over by lava or we can make some adjustments to where we're standing and even possibly figure out how to get into a really advantageous position, but I don't think we can stop it. And so I would start with that.
(36:59):
I think we start with our safe conversation that we talk about. Can I smile at the boss, the implementer of the program? Can I assume good intent? I think how you shoot yourself in the foot here as the associate is you say you go in with this idea that the person is trying to screw you over, right? They're trying to not pay the vets, and that's why you're doing that. I think that is a really bad faith position. And so you need to get into a good faith position to discuss, which is help me understand. Can we talk about what good collaboration looks like for us? So assume good intent. Have they been set up to fail? Are there things that you think maybe they haven't thought about or concerns that you think might come up? What are those? And can we present them in a non-emotional way?
(37:53):
So has the person putting this project forward been set up to fail? And the last thing is the end result. What do I want the outcome to be? I've painted for you the picture of what I think a beautiful outcome looks like. I'm not saying it has to be your end result, but I think that would probably be mine is to say, this is really where I kind of want to go. And I think if you, you know that and where you want to go and you've got a good headspace, I think you're already in a good place to go there. Remember that your relationship between the associate vet and the manager or your associate vet and the medical director or associate vet and the practice owner, remember that it's just a relationship. And in a relationship, everybody wants to be heard. Everybody wants to feel valued, everybody wants to feel respected.
(38:34):
And in all of our relationships, we need to be able to set boundaries. We need to communicate to people where we are, what we're feeling, what we need to go forward, and we need to hear where they are and what they're feeling and how they need to go forward. And so don't go into it as a do or die ultimatums and blah, blah, blah. It's just, Hey, you and I are in a relationship. I want to have clear communication about where my head's at, what my concerns are, what I'm looking for. I want you to know that I hear you, and I'm not trying to be argumentative or shut you down. I want you to be successful as well. Let's talk as two people in a relationship about what we want our relationship to be going forward and take care of each other. And I just think that that's really healthy.
(39:14):
I guess I should go into Headspace, but I think that that's a good action step of get yourself into that place so that we're ready to have an open dialogue so that we know what our concerns are and we can put them forward in a way that the person can actually hear them. I think a lot of times what happens is this is a radical change, and so the associate vets panic and when they panic, they say, this is terrible. It's never going to work. And it's awful, and I hate it. They're unarticulate about what exactly their concerns are. So they go, I hate it. I don't want this. It's going to be terrible. We're going to go out of business, things like that. And I say that I've been, I have a hundred percent been that person, right? Sure. It is very hard when the world changes for us to immediately go, let me articulate the six things that are causing me concern at the moment. That's not how we are. We're like, it's all terrible and it's all burning down.
Stephanie Goss (40:09):
I'm living in a cardboard box in the forest.
Dr. Andy Roark (40:11):
Exactly. This all ends up with me dancing for money on the street corner with a hat in front of me. That's where this ends. And so anyway, a little bit of prep work to figure out. Okay, good headspace, open dialogue, clear articulation of what my concerns are. I think that's where you start this. Do you agree?
Stephanie Goss (40:38):
Yes. And I want to take where this associate started in their letter. So part of the email that they sent to us was talking about what they are getting from a production eligible dollar amount for wellness plan visits. And so they were like, we get X dollars for the exam, X dollars for a vaccine or for a fecal or for blood work, et cetera. And they're comparing it to what a non wellness plan visit would be, right? And it feels like a very big gap. And so this is where we tie the headspace and the action steps together. And to your point, when you're ready to sit down and have the safe conversation, what you need to articulate is help me understand. My immediate scared voice in my head is saying, let's just focus on these wellness numbers. Help me understand what this translates to for my caseload, like my average caseload.
(41:37):
Yes. Help me understand what this translates to if your practice owner or a practice manager has done the why and has explained it to you, or if they have it, help me understand how this could impact my sick patient visits for my actual caseload. And this is a step where so many managers and practice owners, we didn't, and practice leaders, medical directors, we didn't. They didn't go to business school and maths are hard. Y'all like maths is a really hard thing. Not everybody loves spreadsheets the way I love spreadsheets. And so when I did this in my practice, my brain immediately went to, well, if it was me, if I was one of my associates, I would want to visualize it. I would want to know how my production could be impacted for better or worse. What is this going to look like?
(42:37):
And so I immediately went to that place of problem solving from a statistical perspective. Start with that fear and just say, help me understand what that looks like. Now, they may not be able to do that on the spot for you because maths are hard, but it gives you a place to ask for what you need because part of the why should be understanding as an associate who is being paid on production, how is this potentially going to impact you? And using real numbers, not just pretend numbers or statistics that the industry is giving you. I said earlier, my experience was I have had clients spend three or four times more than they normally would or more than their normal average transaction. And that is true. And we know that the industry average is I think 58 or 60% statistically when we look at the corporate practices who track numbers for wellness plans on average, clients spend like 58% more for their visits over the course of a year when they're on a wellness plan.
(43:34):
That's a significant increase. But what does that actually do for my patients in two ways? One, what does it do for me from a numbers perspective and a production perspective, but what does it also do in terms of care and accessibility of care and affordability of care? And I think starting from that place of fear, getting a little bit vulnerable, getting a little bit brave and saying, Hey, I'm really afraid of this. When I'm looking at it and I'm looking at the numbers, my brain immediately is telling me I'm going to take home 50% less. That's how I've done the math. Help me understand what this actually could look like for me. If you said that to me as a manager, I would immediately be able to put on my empathy hat and say, oh, okay. I could solve this problem. Let me help you by answering your questions.
Dr. Andy Roark (44:24):
Yeah. There's two things I want to pick on real quick. And again, we weren't there and we're hearing this through the associates, so I don't know what the messaging was. So I don't know if this was said or if this is what was interpreted or grabbed onto or how this was rolled out. The first thing I'll say is I think if it was rolled out as, Hey, we're going to do these wellness plans so you guys can see more cases in a day, I think that was a faux pas. I hope that's not, when they drafted that on paper, what are we going with? Here's how we can get more cases into the hospital. I hope they didn't go with that as a selling point. And again, it's because if you stop and you think about it, the doctors are going to immediately be terrified by that because they're working as hard as they can and part of the support staff as well.
(45:15):
And so if I could step back and coach the manager rolling this thing out, I would say I might not lead with that. I might talk about we hope that this will be more efficient and we're going to be able to move cases faster and we'll be comfortable later on increasing our volume because this is going to be so much more efficient. But we're going to see how it goes. Sure. The biggest thing is we want to get wellness plans going to help people with payment for their being able to provide care for their pets. And so I would not have led with, Hey guys, the plan is to ratchet up the cases, and this is how we're going to do it because nobody's going to jump on that. It's one of the big things is when you're trying to get buy-in from your team and you're ruling things out, you need to talk to your team about what they care about.
(46:01):
And they're not saying, oh my gosh, I couldn't see any more cases today. Dog gone it. I wish there was a way to run more. I don't know why they're, they're this character, but they are. They've got a big hat and it's made of mesh in the back, a baseball cap. And I just couldn't get another case into my schedule today. And boy, that was sure was a big bummer on my day. Oh, well, they're not. That went somewhere else. But that's not what they're thinking. They're, what they're thinking is, I'm overwhelmed. I'm overwhelmed. And so don't talk to 'em about getting more cases in. Talk to them about handling the cases they have more efficiently so they're not feeling so overwhelmed and they're drowning every day. And that's how we have the conversation. And then crush the program, make it amazing, make it great.
(46:54):
Train those techs and support staff so that you can do this. And then when we're moving clients effectively and efficiently, we can talk about increasing our caseload because we're able to run like this, but I just think, Hey guys, trust me. We're going to make a big jump. I don't know what you're going to get paid. I can't prove to you you're going to make more money. And also you're going to see more cases. That is a really hard sell. And so again, I don't know that they rolled it out that way. I'm assuming they probably didn't, but I would've ro this out in phases and said, here's the why and we're going to give it a try. And my hope is that we are going to be efficient and smooth and low stress, and we'll be able to handle a bigger caseload than we are now.
(47:40):
But that's down the road. And that's kind of how I'd put it forward. So that's the first thing I wanted to pounce on and just sort of say, the messaging here may not have come off the way they wanted. The other part, I would say, to be fair to the managers or owner rolling this thing out, one of the real challenges about this particular change management is you don't know what's going to happen and you can't know. And at this point, a bunch of the ops nerds will push me out of the way and go, “Ah-ha! Excuse me. We have a spreadsheet that explains exactly what is going to happen.” I'm like, you have no idea. You have no idea who's going to actually pay for this. And who's not and what uptake is going to be you don't know. And you should just be honest about that and say, oh, I don't know what the uptake is going to be.
(48:33):
But that does make it hard to go and talk to the doctors because they say, what's this program going to do to our income? And you say to them, I have no idea because I don't know how many people are going to do it. I really honestly don't know. I don't know how many sick things we're going to find on top of the wellness things. I don't know how many people are going to buy a wellness plan and then not come back in to get their services, which is bad for the pet, good for the practice, bad for the doctor. You know what I mean? That's not what we aspire to. And I would be very upfront about that. This is not the gift card scam where we sell gift cards knowing that only 75% of people are going to ever actually spend that gift card, and we're going to pocket 25% of the money and never return a service.
(49:18):
It's not that. And we don't want it to be that. And you need to beat that drum really, really loudly. So anyway, that, I just want to call that out in on behalf of the person rolling out the program as you go. I don't know what to do about this. And so now we're sitting in this place and we've, the doctors are, they're kind of freaked out about their revenue and what they're going to make and is my salary going to crash down? And the owners are, honestly, they're freaking out because they're taking a risk on this and going, we don't know it's going to work. We think we've priced it well, what if we screwed this up and we're just going to get taken advantage of? Everybody's got a lot of stress about this. I think that one of the things that I might ask for as the associate vet going in is to say, and again, the devil's in the details here, but I would go in and say something like, look, I'll make you a deal.
(50:04):
I'll go hard in the paint on this project for you, and I'll go hard in the paint for three months and you're going to guarantee my salary during that time, yes, you are going to pay me what you paid me last quarter. And that way I'm not worried about my salary crashing down, but we are going to do it, and you're going to pay me what you paid me last quarter, and I'm going to go hard for you. And then in three months, we're going to come back together and we're going to both look at the numbers and you're going to show me the numbers and we're going to look at my production. We're going to talk about what my days are like, and we're going to talk about how we like it, how things are shaping up. And if my production is a fraction of what it used to be, and I'm working my butt off here going hard for you, I'm either not going to get on board with this or we're going to need to make some adjustments and changes so that it comes out and it's fair.
(50:54):
But I will give you my word. I'm going to go hard on this for you. I am not going to sandbag. I am going to be in there. I'm going to hustle. I'm going to do it, but you are going to protect me while we pilot this program. And then when it works, you and I are both going to be happy. We're going to high five, we're going to look at the numbers. We're going to figure out that I would've actually made more money had I switched over. And you can either credit me that additional money to really sweeten the pot and say, well, actually, you over earned what I was paying you. Or we can just decide that that's the risk of the pilot program, but let's decide upfront so we don't get three months from now. And I go, great. You owe me more money.
(51:34):
And you're like, Nope. You said guarantee your salary. That's what it is. Let's just work that out now. But anyway, not to get bogged down in the details, but you see where I'm going with this, right? One of the ways to get the doctors on board is you have to protect them. You can't say, I want to do this new program and I'm shifting the risk onto you financially for us to try this anyway. So that would be a big action step that I would kind of go in and say, this is what I need to get excited about this. And it's not forever, but I will pilot this with you and I'll be your champion, but you're going to protect me while I do it. And then we're going to both have a real transparent look at the numbers and how it went and what's fair going forward.
Stephanie Goss (52:18):
I love that so much. And here's the thing. I think a lot of us as leaders, when we're setting up things like this, think about it in terms of forever. We think we have to go all in on wellness plans and there's no going back and we can't change things. And the reality is you're in charge or maybe you're not. If you're in a corporate practice, then maybe somebody else is making the decisions. But there is always some measure of control. And to your point, I think there is always the ability to have the open and honest conversation and say, this is the timeline. This is what we're going to try, this is how we're going to try it. This is how we're all going to show up and commit to each other. And then we're going to look at it. And so if you start doing wellness plans and six months in or 12 months in, you're like, I would like to make changes, do it.
(53:13):
It doesn't have to be, we decide one thing this year with the team that we have, and then a year from now your team looks completely different and you can't change it. You can better it for yourselves. You can better it for your clients, you can better it for your patients. We have got to stop thinking we're going to make this decision today and this is the decision that is going to live on forever. Because I will tell you to a point that you made that is really good one at the beginning of this conversation is that it is a process and it is from a workflow and efficiency perspective, if you already have inefficiencies in your practice, wellness plans are going to highlight them like there's no tomorrow and it is going to be a rocky road to get to that vision of done.
(54:00):
And eventually if you keep plugging away and everybody keeps rowing in the same direction, you will get there. But it is not a smooth and easy process if you don't have a lot of that stuff hammered out. And so I think from that perspective, leading this project is really important to put the hat on of “when and how do we make the changes?” And I think it's great if that suggestion or that ask came from the associate, I would love it. And I think as a leader, don't be afraid to go out on that limb and say, this is how I'm going to help minimize the impact to you. Whether it's to the team who's getting paid on production or doctor who's getting paid on production or just the overall volume in patients. All of those things like factor that all in and try the thing. It doesn't have to be forever.
Dr. Andy Roark (54:51):
Right. No, I agree. I think that's pretty much what I got. I think that would be my headspace going into it. I hope I painted a good picture of what this can look like for doctors and how it can be good. I've said it way too many times, but I'll just go back to it again. The devil is in the details in a lot of this stuff. How is it set up? I think there's also strength in, I said I, I'm agnostic as far as paying doctors on production versus paying 'em on salary. They just have different headaches. Neither system is perfect, they just have different headaches. And I'm like, salary doctors can be a way around these sort of compensation headaches. But honestly, there are a lot of practices and honestly, big corporate practices that leverage wellness plans and pay on production. It can absolutely be done. It can be done very fairly.
Stephanie Goss (55:44):
Yes, I would agree with that. And that was kind of the last question that had been asked in the mail bag. Is there a middle ground where everybody comes out well? And I would say in my personal experience, absolutely. Yeah, there has to be. Absolutely. And I would say one of my close friends practice kind of was a model for us because they had been doing wellness plans for longer than us, but I will tell you had been, by the time they had been doing wellness plans for eight years, they actually had 80% of their patients on wellness plans and their ACT was well north of $300 per visit. Yeah. Which that's great. Which is great. Great. And it was the patients were getting care and the clients were happy. And so it absolutely can be done. It takes time, it takes focus, it takes talking about those details. To your point, Andy, and so I think my message to our associate writer is like, don't be afraid to ask those questions. You should understand the why and the how, and to your point, do it safely. Think about it. Think about what's making you panic, but write it down and then ask for it. Yeah.
Dr. Andy Roark (56:50):
No, I agree. All right. I think that's all I got.
Stephanie Goss (56:52):
All right. This is a great one. Take care everyone. We'll talk to you again soon.
Dr. Andy Roark (56:56):
See you everybody.
Stephanie Goss (56:58):
Well, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mail bag and answer this question. And I would really love to see more things like this come through the mail bag. If there is something that you would love to have 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.
