The Veterinary Practice Team In 2024 And Beyond

Host: Hello everyone, welcome to the veterinary business podcast, your ultimate resource for developing a successful veterinary practicing career. I'm Dr. Peter Weinstein, I'm one of the co-hosts of the veterinary business podcast. On this podcast, we bring you insights and expertise through industry leading doctors, experts, technicians, credential technicians, thought leaders, and anybody who's willing to talk to me. We cover a wide range of topics including practice management, marketing strategies, leadership development, HR best practices, and much more. Whether you're practicing veterinary in a practice owner, practice manager, veterinary team member, or students studying to be a veterinary in this podcast is tailored to help you navigate the unique challenges and opportunities in the business of veterinary medicine.

Host: Every listener of this podcast is welcome to visit the www.v veterinarybusinessinstitute.com for additional resources and tools to support your growth. And remember, you can subscribe to our podcast on iTunes, Google Play, Spotify, and any of the popular podcast platforms. After all of that formality, I am excited to welcome a good friend, a colleague, an influencer, and somebody who have a tremendous amount of respect for. I'd like to welcome Heather Prendigast, registered veterinary technician, certified veterinary practice manager, and chief executive officer of synergy consulting to talk about the veterinary practice team in 2024 and beyond. Yeah, I know it's a broad topic, but welcome Heather.

Host: So good to hear you and see you. Thank you so very much. It's a pleasure to be here, and as always, to have good conversation with you. Yeah, we don't normally do things formally. We usually just sit there and throw stuff at the wall and see what sticks. So we'll do a little bit of that today as well. And then you and I know each other, and I know you, if the 35,000 foot level, but let's dive a little bit deeper into your background, because you've got a lot of credentials after your last name. How did you become interested in veterinary medicine?

Host: You know, it is probably like so many stories that we have with people that are in veterinary medicine. Yeah, as a child, you always dream of going into veterinary medicine. And I had a veterinary that we used to take our pets to when I was super young. You know, when I can start remembering going to the veterinary for example, he always got me involved in our exams. I got to listen to the heart. I got to touch the abdomen. I got to feel lumps or bumps. Whatever it was is just that he was serving the needs of an inquisit, quick, a kid that just had so many questions.

Host: And that's really what drove it. I always wanted to be veterinary at that point. And I stayed in, so I started as, you know, under age, working in the kennel in sixth grade. And so it healed my passion. I learned a lot. I stayed working in a veterinary hospital through high school when I moved to college. Same thing as I just picked it up. So I continued working in this industry and being in private practice. And my last practice for 20 years is really where I think I started

Host: honing in on my really my wants and desires to be a credential veterinary technician. And you just sometimes naturally fall into those leadership positions, such as practice management. And you learn trial by fire back in those ages. We didn't have tons of resources available to help us grow. So I think, you know, so many of us. We want to go to veterinary school. We might apply to veterinary school. You don't get in. You just become resilient.

Host: And you're like, okay, what's the next thing I'm going to do? And I am so grateful for not getting into veterinary school in the multiple times that I did apply because I wouldn't have what I have today. There could be different things that would have come out of it. But I, I absolutely love what I do. My journey that I've been on and would look back to change anything for the world. Now you live in rural New Mexico now. Did you grow up in in kind of out in the country or were you more of a suburban kid or? I was a country kid. I grew up in northern New Mexico.

Host: I graduated high school left as fast as I could. So the southern part of New Mexico where I had a little more warm, but mostly four college and then just never left once I graduated. So you, you liked so many are a statistic of the system. I, I kept applying and finally got in on my third application. But you got, I'm going to use a term I really hate using. You pivoted and went from the DVM to the CVT. I did. I did. Whichever acronym is correct, depending upon the state that you're in in your case, it's an RBT.

Host: So you went through, did you go through the formal RBT curriculum and the educational process or? I did, I, and I did an online program. So I was one of the more of an original online learner where we still had to submit video tapes of our skills and all of our slides and things. But it was, it was still a great learning experience. And, and for me, it was a, it was a great learning experience because while we had a good hospital that we did things. The way we should have done this program challenged my mindset to look bigger and broader. And so yes, I did do the official, the whole schooling processing sitting for my national estate exams. Yeah, it was, I certainly don't want to take that exam again. I'll have to say for that. I, I've heard the VTNE is, well, you put the VTNE and the Natalie next to one another.

Host: And I, I hear more technicians complaining about the VTNE than I do veterinarians complaining about the Natalie. So I, I understand and feel your pain. I appreciate the fact that you are a trend center in using the online approach to your education. And I think we're seeing more and more of those options and especially as technology has improved. So I really appreciate that, that thought process because I'm going back 20, 25 years. And I think that's when I remember seeing the first online course at St. Petersburg if I'm not incorrect. That's my alma. Yep. St. Petersburg College. And I thought it was great because it allows the technicians before they get their credentials to continue to work and be educated because let's just be honest. Most of us in the position you were in could not afford not to work and couldn't afford to go full time and have a, Well, probably at that point it was probably a 30 or $40,000 debt to go to school.

Host: So this gives you some flexibility and I appreciate the feedback and the positive feedback you gave on it because I do think it could be motivational to those who are non credential yet. But are looking to have that work and career balance. So if I'm hearing you correctly, you, you deen this to be a very viable option for those who want to balance work in life. It's viable and it's what you put into it. Just like everything else you have to put in the time the skill to do it and one of my biggest recommendations that I have for those that are in online programs is you have to move outside of your hospital. You can't just focus on we often focus on the things we know as we're studying for that exam or learning for it. And so what we already do in our hospital are the things we do great at and then other things just don't seem as important. But if you will visit the other hospitals as you're supposed to throughout your curriculum, you're able to get more skills, which makes you more versus how when you're taking that BTA knee. And that was probably one of the, we had a lot of hours that we had to do an externship in the shelter medicine in large animal, you know, in various animal small animal practices. And I feel that that is what made the being able to pass the BTA knee the first time much easier is because it made me realize where my gaps were what I was strong in and what gaps I needed to get better at as I was learning and study.

Host: Well, I would concur that even young veterinarians should get experiences that are multitude of hospitals before they go to their final resting place or, you know, find up next job or even owning a practice because I think the more the more you see the more you learn. And if you replicate, if you're going to start a hospital and you replicate the only practice you've been at you're also going to replicate their mistakes. Absolutely. So, did you think that you would ever be on the management side of things as you were going through putting in catheters and trickings and all that and you probably did some e-coin because I know you like horses. So did you do some e-coin teching as well? I, we were small animal, but we had our own horses. So I did all, yes, all my own teching and practiced on my horses, but. Yes, and, you know, how did I get interested in management? It was, it was, I'm not sure that I was necessarily interested in it. I never planned to go there. I wanted to be the nurse that to care of all of our patients and I found great joy in that. And it's like so many hospitals and there's a gap in training and helping others growing others, coaching others, somebody being held accountable for showing up on time. And so it just became more of a slower progression into that role without realizing what was really happening.

Host: So you kind of Peter principleed in as well. You know, I did. Which we do do a lot of people like yourself who show ability. It's like we don't consider that you really want to be a technician in the rest of your life. We give you a title. And then, and then you have to live up to it. Absolutely. And that's really created the first edition of my book is that so many things that I did in practice. Again, just pivoting and adapting was that we didn't have a lot of resources at that time. There was maybe a few. Mark Gopperman's book was available at that time and I don't even think Dr. Marcia Hainke's book was available yet. And so those resources were so limited on being a successful practice manager or moving into that role. And that started the birth of here's what I learned how I adapted how I made it work and how it ties to the HMA then as I was sitting for my CVPM. So time to plug your book.

Host: All right, name. Where can they find it? I don't have a copy of it. The previous three editions is the front office management for the veterinary team. The fourth edition is actually coming out this March. And it is retidal practice management for the veterinary team because it's more appropriate as I have adapted over all four editions. And while Elsevier would always say you just need to rewrite 25% of the content to be the second or third edition. I have almost completely rewrote the book 75 to 8% of the book with each edition. So that was the we need to change this title to be more appropriate for what it does serve versus just the front office. It is all encapsulating all areas of practice management, including finance and strategic planning that we often don't do well. We will be looking for your book in March and we'll be looking for a book signing at the most at the local Barnes and Noble or probably at a veterinary conference. Hopefully. Hopefully. Yes.

Host: So you joined the VHMA, you recognized you must have been a relatively early member of the CVPMs because there's only just over 1000 now and it's been a slow growth from that standpoint. So were you an early adopter on the CVPM side of things as well? I wasn't early adopter. I think, you know, we had there was many of course that I always looked up to. I felt like it was many. There was probably 10 QCV cans at that time that really kind of started modeling what I wanted to look like as far as I was leading, you know, practice management. And I would see them at our national conferences and they would stimulate that excitement that, ooh, maybe I went to get outside of just my hospital and I want to speak and I want to write more. And so yes, there was definitely the early adoption of it. And learning many of the great competencies that I didn't have established in my hospital yet, and you don't learn as a veterinary technician. And so that really is what fueled further is the management leadership portion of my career was being a part of the HMA. Being a part of the forums that were there and and just learning from fellow CVPMs that always inspired me. So let's do an unabashed plug for vhma.org, where you can find out how to be a CVPM as well.

Host: And I would suggest whether you are a veterinarian, whether you're a credentialed technician, whether you're a manager that being a member of vhma, which I have been for 36 years, I believe. If you read nothing but the listserv that comes out every day, you will learn where the issues are, where the pain points are and what mistakes not to make so. Absolutely. And there's so many people and smart people that are there to give great ideas that you don't have to troubleshoot and think through all of that. The great ideas are there. If you just take the time to read that forum each day. Yeah, so go to www.vhma.org and join now. Okay. So you've been a CVPM, you've been a credentialed technician. And let's talk about some of the issues that have been coming up in the veterinary platforms over the years. And the first one you mentioned the term nurse in one of your answers earlier. And there's, you know, I grew up in the profession looking at some of the people like Mark Operaman in Tomcat and others who use the term nurse regularly. And now it's become a bone of contention, the lack of a better way to put it.

Host: And I'm very sensitive to my colleagues who are credentialed technicians and also those who are technicians who want to be credentialed to give them the respect that they have earned. But we need to figure this out. And we need to be consistent in the way we utilize our terminology. So if you're comfortable, are you in the nurse camp, are you in the tech camp, or are you trying to bridge the two camps and what, what's your, which camp do you play in? My personal camp is veterinary nursing and that it, those, of course, those terms always have to sit together. It's not one without the other. The reason for that is that our public and even in my own hospital, our clients didn't understand the difference between somebody that was credentialed or somebody that was a veterinary assistant. And while our veterinary systems were very well trained in our hospital, they could not do this things or carry out the tests that I did as a credentialed veterinary technician. And then I was the only one there. And so then as we started trying to put forth more education for public about what a veterinary technician does. There's no concept of what a technician is. They think of an IT, you know, IT technician, a, you might have a fiber optics technician. You have all of these technicians that do specific things in other industries, but don't relate necessary to the nursing care that we provide our patients. And if you ask somebody what a veterinary nurse is without giving them any specific, they're like, oh, that's somebody that cares for pets.

Host: You provide all of the TLC, you might have, you know, your sick patients, maybe they need fluids or blood work, they can understand that. And when you are trying to drive value for this profession, we can't drive value in my opinion with just the term technician because we don't have enough public outreach. The money to generate that public outreach about what a technician does. So if we can at least start 50% closer and educate that we have a credentialed veterinary nurses, the value of what we provide those patients is that much more hype. And that's why it becomes such a passion for me is that if our clients are going to understand everything we put into our patients as credentialed technicians or nurses, then they have to understand the schooling that we put into it that it's very similar to what a registered nurse does. And in fact, if you put those curriculums next to each other, the veterinary nursing curriculums are usually much stronger than even not of the registered veterinary or the registered nurses. And so I fully understand some of the human nurses that wish to protect their title of human nurse. There's very different perceptions of the in of our public that they know what a veterinary nurse is. And there's no confusion of your veterinary nurse, you can go to work for a human.

Host: Like they're when in survey, they just don't show that. And so as long as we're always using that term veterinary nurse, and it's reserved for those that have gone to school, graduated past the VTME. And even for those that are grandfathered in from history, though the understanding from the public is there. And as we are in this conundrum of where our industry is at this point about not being able to attract talent, retain talent, drive value for clients. This is a piece. This is a piece of that and until we tie it all together, until we solve it, we are going to continue to be in this conundrum. And that'll drive me back to my feet, my other soap, my passion is that we have to fix our title. The title, if we choose veterinary nursing great to drive better public perception. But we can't have a licensed veterinary technician, registered veterinary technician, certified veterinary technician, certified veterinary medical technician or licensed whatever it is, whatever state it may be, whatever title. Our own industry is confused by that as is the public. And until we come down to one title that serves all 50 states, one set of standards that are required in every state. We are going to be in this conundrum.

Host: And even if we were able to accept the term veterinary nurse and understand that that was reserved for those with credentials, the term is going to be abused until we have those specific requirements in each state. Yeah, there is one thing about veterinary medicine. The one thing that veterinary medicine is consistent about is its inconsistency. And I think your your point about consistency with respect to title goes back to title protection and the fact that there are certain states that don't even really recognize credential technicians. Yes, there are certain states like California that have a very significant list of those tasks that only credential technicians can do. And there are those states that really have gone out of their way to just ignore the profession that you're in. So which only contributes to one of the the comments you made earlier, which is about the longevity or lack of longevity of somebody who's made a commitment to either a two or four year education or or lengthy process if if you know if you're going through some of the alternate routes that are available out there as well. And you know we know that the average life expectancy of a credential technician in this profession if I'm if I remember now to studies in the past is somewhere between five and seven years seven years that's that is our highest that we've done to help me. It's it's painful to think that you would make a commitment of education and time, but you go out there you get a credential you get a a pitence of a pay raise and are expected to do the same thing that frequently non credentialed. And it's just technicians are being allowed to do because we don't have a definition of what panor cannot be done so I correct me if I'm wrong in anything I just said. I know you are a hundred percent spot on and why do I want to go to school come out with a thirty to sixty thousand dollars student death depending.

Host: Where I went to school if I did a two year or four year program and then compete with somebody that doesn't have debt who doesn't understand the why behind what we do. And feel like this is going to be the profession for me in my opinion until we put the standards in place we're going to have a vicious cycle where. I've been educated but very well trained veterinary assistants are competing for that same role and like you said very similar pay structures. We're never going to move the bar there's no need to go to school if I get to do the same thing in somebody else's mind unless you want to further your career further your advancement. You know as a credential technician for those that have lasted more than seven years it's usually not because they have stayed within their same hospital for that length of time. But they have found ways to challenge their own growth and their own innovation and they've looked for things that will feel their passion outside of the veterinary hospital. And that's unfortunate it's unfortunate that in that mid that we are so consistent with not changing things and doing things the way we've always done them in that perspective that it makes it it's very safe for somebody that doesn't want to do more with the skills that they have. So and there there's no real answer to this question but is this is this a result of the state regulatory boards. Is it the result of the state associations or is it a result of the veterinarians or all three that some of these states are just totally unwilling to catch up with everybody else. It is all the above right I think that AVMA has a large role that they can play in advancing technicians veterinary technicians and in outlining the standard scope of practice that credential technicians should be able to complete.

Host: They already support our you know we have AVMA accredited programs and so by trying to create some type of standards that each state would abide by is a starting process followed by. Being able to create a model practice act in which they do have a model practice act but being able to out the states in you know each of the the boards of veterinary medicine in each state being able to implement those scopes it is a hand in hand partnership process when you don't have a good partnership. The state is when you don't have recognition of what credential technicians can do so I think that it is it's all the above situation we we need to figure it out or we will continue in the cycle again for another 20 years as our industry continues to cycle down. The salary seems to have bumped up a little bit in the recent times which is nice to see some of that I believe is coming from corporate some of that is is coming from a need to. If technicians a salary that which that they with which they can live. But I think you noted and I noted earlier that the credential technicians frequently are not being paid that much more than the unlicensed or the certified veterinary systems that standpoint. Technicalization there's got there's so many things running through my head right now but is longevity in the profession or if the lack of longevity the seven year life expectancy I mean a good Scotch takes longer than seven years to age. But is is the lack of longevity a salary thing is it a respect thing is it just a failure to provide growth opportunities is it utilization. Is it a multitude of issues what do you think is the is the cause for the longevity or the lack there of. There is definitely a combination of all of these factors and most of our surveys will indicate that money is usually not the top of it yes salaries important yes we need to live in in some play we need to live in some way not in poverty.

Host: Especially if we are single moms carrying a family but when you when you look at the overall impact more people leave this profession not just our credential technicians but because of for culture. They experience burnout they don't have trust they don't have innovation they're not allowed to you to be utilized to their fullest potential. So everything plays a role in it but at the end of the day if you don't have a great place to work it doesn't matter what your salary is nothing is good enough to compensate for that horrible work place environment you spend a majority of your time there. So when you don't have psychological safety when you aren't utilized when you can't contribute when you don't really get to see what you do aside from a task list every day. Your enthusiasm dies your burnout increases and you want to leave the industry as a whole not even find another hospital that maybe has great culture or great leadership that stimulates that innovation and that creativity and creates that safe environment. You just put your practice manager hat on there didn't you. It all ties together. Well I want to go there in just a minute because I think we need do need to talk about culture and trust and innovation it's psychological safety but want to talk about. Utilization and maybe probably wrong terminology and saying this but return on investment because I think the more at least in my experiences in working with credential text. The more they're utilized to the top of their job description and their skill set and what you trust them to do and if you don't trust them to do it it's because you didn't train them to the trust that you need.

Host: The more valuable the practice becomes the more profitable the practice becomes and I know there's been some studies from AVMA and I think Ontario VMA about the value of a credential technician to a practice but why do you think many veterinarians don't utilize technicians credentialed specifically to the top of their their skill set why do you think veterinarians are hesitant to do that. I think there are two gaps one is definitely the trust the second is that they don't know what credential technicians are educated about in curriculum they don't understand the intensity of the of the curriculums and what we are challenged to learn especially with the on site programs and then when you're when you are online you have to go back and do those skills within your hospital. I think that a majority don't know what the skills that we come out with secondary is that we always expect for some reason our credential technicians to be able to come out and get the ground running they know everything so we don't provide them a mentorship program. We'll then you often hear them say well my experience veterinary systems can run circles around my credential technician but we don't say that same thing for doctors. We don't expect a new graduate to come out of school and be able to hit the ground running like somebody that has 10 or 15 years experience we've created mentorship programs to help them succeed. So another area we're lacking in is that we don't let technician we don't put that mentorship program in place for technicians to grow their confidence to allow them to challenge those skills if they learned once or twice or three times in school. And they need to be able to ask the questions of their doctors to help build that confidence and make sure that we are doing it again the way that's going to work for our doctors there are so many different ways to do things but if that trust factor and. You're not going to delegate things to me or empower me Peter if you don't know my skill or you don't see me demonstrate those skills so. I think there's there are so many things that contribute to that creating a mentorship program I think is required that we don't often do there are some companies that are not now starting to build that it causes the technicians to leave. The experience way we've always done things will often create a toxic work environment for those that are fresh out of school.

Host: Which creates an intimidating environment and they just decide to leave they don't need to put up with that they can go somewhere else now that there are so many work opportunities. Fordentials can't credential technicians can leave and look for a better place if they're willing to try or many will just leave the industry. In my opinion to credential technicians could delay the need for a veterinarian. Oh heck yes hands down I mean if you you could be a single doctor practice. And produce multi million when you have say five credential technicians that allow you as a doctor to prescribe diagnosed and do surgery and they do everything else. They can manage the case they can help build out the treatment protocol they can do the client education they get to allow the doctors to practice at their highest level. And so being able to practice at that level is exciting for veterinarians I know it's still fun to put catheters and things in sometimes but when you're not when you don't get to practice doing those things out of time they become less fun for doctors. So allowing those that do it well do it fast is way more efficient for the hospital is much more cost effective than having the doctors do those things. So we have to invest in those technicians and empower them to be able to do everything that the doctors cannot do and that's where we lack so much in our practices. Taking out the next net next notches now we can pay the credential technicians for what they do and what they are worth because they aren't producing closer to 200,000 a year per credential technician.

Host: So why wouldn't we have more credential technicians using them at the highest level and capacity that they can do empowering them through advanced level training of CE so if I'm a single doctor and I can't get a doctor but I can get a credential technician to stay and I create that environment I'm going to still have a thriving practice and be able to pay them well. And in those states where you can why don't you give them some ownership as well of the hospital. Absolutely. So two quick topics and then I want to move on to your other your CVP on discussion. VTS thoughts. VTS I think are absolutely valuable that are near technician specialists they the as I look back onto my my technician career they are the smart people I surround myself with because I don't know all the answers in internal medicine or cardiac or nutrition or. Dentistry whatever it may be but I have a lot of peers that are incredibly smart in those areas I don't have to know all of those things but if there is something that stimulates me the technician and my my area that stimulating me was nutrition. I we I can specialize on that area and I can bring a whole new profit center to my hospital based on my advanced level experience as a veterinary technician specialist. So I think they play a significant role in the future of veterinary medicine if we would just elevate them utilizing for their advanced skills and allow them to provide those professionals within our hospital. Which leads to a controversial topic and one that I'm not sure where it's going to end up which is this concept of a mid level practitioner.

Host: You know it's been hot and heavy headline news it's been discussed heavily at AVMA as a credential technician as a certified veterinary practice manager as a consultant and as a leader. What are your thoughts on the the need or the role or the potential for this so called mid level practitioner. I think there's potential for the future it's not today and the reason is we don't have standards in place to protect that title to provide a scope of practice. And we are going to have the exact same situation we have now veterinary assistance calling themselves veterinary technicians that don't have the education to fill that role. We are going to have out of protection issues we're in have name issues we are going to have accountability issues until we put bases in place within legislation. It's not the right time if we put that part before our horse it's going to fail in our future and we're going to be right back where we are today. So let's instead not rush into it let's take the time to build it right then we can move forward and make it successful for this industry. Okay, let's let's give you your your tech had a break and put your business hat on. As a certified veterinary practice manager one of only a handful I like to call CBPM's board certified practice managers. So you're a diplomat of the American College of Veterinary Practice Management.

Host: For all you board certified clinicians listening in I'm not belittling you I'm building up the CBPM's. The same issues with credential technicians occur with practice managers in terms of utilization. Yes. And whether you're a CBPM which means you've really been through education and testing and continuing education or whether you're a Peter principle technician who's now by title a manager or client service person. At least in my opinion, I don't think we have a crystal clear game plan for the optimal utilization of our management team would you agree with that as well. I would 100% agree with that. I think that so many practice managers only get to do office manager tasks and I think of office management tasks as yes it's accountable we might balance our books at the end of the day. We still check clients in and out because I'm still working at the front desk I still make appointments I might on handle client conflict and that's my role. We don't have a good use of it whereas those that utilize their practice managers well that are experiencing those with CBPMs. They need to be doing and should be doing much more of the people portion of the success of our business because overall our business our team.

Host: What we do is they practice managers should be growing and developing and helping our own team innovate finding what what drives them creating a culture creating a trust creating success for everybody on our team. When I'm serving in an office manager role, I have no autonomy to be a leader because I'm not making decisions I'm just directing the parents that work underneath of us to repeat the messages. When you're in a practice manager that is utilized to the top of your skill you're able to create those programs you can create motivation you can create safe. And so for those hospitals that are having difficulty driving the success of the practice or perhaps being profitable. Many times it's because we have stifled that practice manager into an only office management position. And so I think you know the interesting thing is you've used practice manager we use the term administrator we have CBPM and I would bet a very large percentage of practice owners including corporate. Clearly understand what the job descriptions are and again a club for vhma.org they do have clear job descriptions for practice manager office manager administrator and what the expectations are for CBPMs. And so just as we've talked about clear tasks for credential technicians there is even I would suggest there's more clarity at least through vhma of what the task lists and the expectations are for practice manager office manager. Absolutely there are very clear expectations very clear competency the support it yes I think it's more clear than what we have for technicians agree a hundred percent. And so for the listeners who are trying to figure out whether you have a practice manager and office manager administrator or whatever you want to title them.

Host: I strongly suggest that you build a formal job description with expectations and one of the best places to find that would be on the vhma website from that standpoint. Because the minute you have greater clarity the minute you can set greater expectation so if I want Heather to do bookkeeping and print out. Key and else at the end of the month and be able to review them with me then that goes in the job description. If all Heather's going to do is go to Costco and buy toilet paper well I think we're under utilizing has the Heather skill set from that. Absolutely. Now of course if you are the veterinarian going to Costco to boy took by toilet paper we're talking about. Yeah that's even further under utilization of your skill set. So we we can as veterinarians and I'm going to speak as as a veterinarian we can improve our efficiency as a doctor with credential technicians and then we could add another level to that with practice manager. You can see VPM or not the administrator office manager doing those tasks that aren't diagnosing prescribing and doing surgery. So how much do you think we could improve the efficiency of practices with the goal obviously to be 100% efficient.

Host: And the average being probably 50% how much do you think we can improve efficiency by greater utilization of let's start with the practice manager. I think there is so much improvement and it all starts at the top this is leadership driving the trust in the culture that that creates utilization amongst the team as a whole. But in my mind medicine and practice management are married you can't have one without the other you you practice medicine but what you put in place on the practice management side have to go hand in hand. What we create as protocols or marketing documents or wellness programs comes out of the birth of the medicine from the doctor but you have to have a team that drives it. It's the practice manager that should be tying all of those together for the team providing and developing all the client education pieces the tools for the team to be successful develops all the marketing pieces. So those have to be married and when a doctor is trying to practice medicine and do all of that now we've stifled the efficiency of a veterinarian which has ultimately stopped our revenue flow. The more that we can do to be efficient the more the doctors can generate revenue that healthy our practice is going to be. So many practices the owner doctor focuses on doing both medicine and trying to lead the practice and that's where we become across the failures. So let's let's put your your third hat on for that we have very many hats you have I'm sure you have a steps into. Let's talk about Heather as the consultant the hospitals you've touched metaphorically and you talked about culture trust innovation psychological safety lack of mentorship toxic work environments.

Host: So that's a pretty broad brush but I don't disagree with you I'm spot on and in that respect and you you address something about a few minutes ago about leadership and as you know I'm a big advocate for improved leadership. Do we as a consultant do you. Do you think that that you can go in and change leadership. Yes. Good. I think you you have some people that are definitely have more innate leadership skill that get it there's others that need a lot of coaching but where there's a will there's a way and they are willing to make that difference. It has to be a person doctor or owner that wants to be a better leader that can coach and grow people instead of telling them what to do. And so really when you're creating that driving a good culture with a good leader it's teaching them how to reframe everything they already know or do. Into creating positive momentum for the team through critical thinking through problem solving together through collaboration they've just often done it so long by themselves they just help people what to do. So when you teach through consulting how to change that how to ask questions instead of tell people what to do but you ask and they think and then they can problem solve on their own that's what changes it.

Host: There's now there's a small percentage that can't change the way they've done it for 30 years but it's more because they're not willing to change the way they've done it and that's okay that means that we are probably not a good partner together. And I will focus on those that want to make the change want to positively influence people and have a better outcome on those that work for us in our hospitals. I really do think that one of the weaknesses of the veterinary profession globally at all levels and all the different silos. Some of which we've talked about is a lack of strong leadership. And it is also our least attended lectures at conferences it is between that and financials or strategic planning we avoid those topics. Probably because we are so uncomfortable with them that we're going to find something that resonates with us versus exploring things that will challenge our growth zone. Yeah kidneys and liver and heart so my is a lot sexier than leadership and culture and psychological safety. Oh my. Yeah and here we are and I'm going to we're going to go a variety different topics and I'm just going to spit both some of this stuff but let's I want to talk about mentorship because you mentioned. And I agree with you a thousand percent we're so focused on mentoring young doctors that we forget about the other members of the team with whom the doctor couldn't do anything to mentor them.

Host: And I would suggest a very high percentage of practices we set up everybody to fail because we don't give them the resources or the support to be successful and whether that's job descriptions whether that's training formal training whether that's an operations manual whatever the case may be. Why would a technician be any different than a doctor than a client service person and an animal care taker when it comes to the need for mentoring. I mean correct me if I'm wrong but shouldn't we really be mentoring the entire team from the day that they start. Absolutely and that creates a phenomenal onboarding program but we are very guilty of we hire fast we fire slow and we train people for two days and expect them to be the best employee ever when all we do is we set them all up for failure. So again back to the practice management role is if somebody is empowered to grow the team and they can build good onboarding programs that influence create mentorship in all of those roles we have to do it we have to do it for the success of the business for this industry. What is what's your definition of culture culture is in my opinion a collection of the values the beliefs the behaviors that we demonstrate together that we believe in. With in our workplace environment when you have a great culture it is because you have somebody leadership that has influenced others empowered others built trust built that psychological safety it is a collaboration of the entire team and while leadership is responsible for creating and maintaining the culture. The entire team contributes to it through their actions their behaviors and their values and it is leadership's responsibility to find the right people to join our culture instead of finding more bodies that often bring the toxicities into the practices. So culture to me is core it is core that drives financial success it drives longevity it drives attraction like we have to have culture to be successful in our future businesses. So what does it tell you about a practice that really has no clearly defined culture well I'll tell you through consulting when I walk into a hospital I can feel when the culture is not there just as our clients can feel the client the culture is not there so that is up most important that is the main thing in my opinion that has to be developed to be successful.

Host: It is the first of everything else we do without that culture I think we we have so much more work to do and as you've noted. When you have no leadership you tend to have no culture and you can have a practice team that tries to create a culture only to be pushed down from a leadership standpoint. So it's really about a collaborative delivery of healthcare which the term collaboration is really interesting and I'm sure you see this in practice is where you have 10 or 12 staff members all working individually almost like a group of male dogs excuse the metaphor. Territory protecting their turf yes and in my opinion that starts at the top that means somebody at the top is is turf protecting as well. I think in my opinion and in my observations everything starts at the top and so every behavior a leader demonstrates and you're a leader by the role as an owner as a veterinarian. You are a leader so everything you do and say matters because that is how your team is going to act or that's what they are going to do that's what they are going to say that's how they're going to carry themselves. So when there is a territorial piece at the top the entire team is going to continue to demonstrate those behaviors. So one of the classes that we learn in veterinary school and I believe you learn a little bit in tech school as well is toxicology but when it comes to toxicology we're learning about the toxicology of Tylenol on cats and we're learning about toxic plants and we're learning about well my daughters in Australia let's just say everything is toxic in Australia if it's alive. But what we're not learning about is toxic work environments and I agree with you I think a lot of our problems in veterinary businesses a lot of the reason that profitability aren't where they should be is a lack of leadership and subsequently a toxic work environment. Because I think what we do is we let toxins in we hire toxins because as you said we hire slow and I don't know whether you'll agree with me or not but I think veterinarians are hoarders.

Host: We haven't had a TV show about veterinarian hoarders but you could probably start with me and look at my storage shed with journal of jabma from 1987. But we hoard staff too don't we try. We try to hoard staff the wrong ones and we don't let them go but the good ones the good team members leave quickly and so toxic just becomes rampant and that becomes the culture of the hospital is that toxicity. Being able to get profitable with that. I think the good ones walk in and they smell something bad it's kind of like sulfur or something like that and they walk out. You know what's often made me think about you think about the number of people they go after interviews and they just don't even return a phone call what do they smell when they do that initial interview. Is that what type of culture is this no not going back not even returning that phone call. Interesting if it how many client service people who feel that they need another client service person when a client service interview e comes in don't greet them don't make them feel comfortable shine them on and this is the person they're going to work with. Or for and the person who's sitting there is looking at this and maybe we should I don't know do you do a sniff test maybe we should do a sniff test on practice as you walk through the door. I'm out of here so how do you detoxify a hospital what what do we do a do a saline cathartic do we do an emesis how do we detoxify a hospital.

Host: It starts with leadership and and honestly if what are you willing to do what are you willing to learn are you willing to have a self evaluation to understand. If it's as a leader or as an owner you never think you're doing a bad job you don't come to work intentionally setting a bad culture or. You don't talk to city to brew you just don't know and we often think that we are good leaders because we we have a business that is surviving not thriving but we we're just getting by and the perception of what our team sees of us. Is often very different than what we see of ourselves we can look at ourselves in the mirror and question am I the big lion or am I just you kitten how does my team perceive me. But until the team has a safe anonymous maybe 360 evaluation that they can provide a leader there's not going to be change. And so it has to be very mature of an owner to be willing to to do a good self reflection and a good deep dive and get the perception of the team and be willing to do something with that. Versus getting offended and saying all just get rid of all of them because if the common denominator is me as the owner I need to change what I'm doing to have a better outcome the next time because that's the definition of crazy is to keep doing what we've been doing for the last 30 years and it's still not working. Yeah, I love that 360 degree review but as a leader to scare the heck out of me. It is scary. You know as a faculty member the students review me and as a faculty member essentially I review them as a when I worked in corporate for what was VPI now nationwide and I had this staff you know evaluating me and even at SCVMA when I was the executive director in the board was evaluating me.

Host: I have a hard time looking at those even though most of the time they're good. It's at one thing that keeps you up at night and but that's the one thing that needs to change and that's the one thing that most of us don't want to change. And we often hone in on placing blame for others on that one other thing and that's where we have to really catch ourselves and retrain our brain that it is not it's not placing it's not about the blame or who did this or who did that but I as a leader how can I instead influence positive change instead of placing blame let's go back and redo this in a way that I can influence people more positively. And I have seen some remarkable changes from 360s in veterinarians that have just blown my mind they're the result of a 360 are really hard to deliver it's delicate because when it's your first time as you said they're scary the horrible you beat yourself up we're perfectionist in this industry by nature. So having that feedback is really difficult and how you take it can be difficult and I've asked just seeing the change and the leadership style and the open communication that a specific veterinarian that I've recently worked with to see that change is amazing and for team. As just started I mean they they are empowered they the revenue is increased her ACT is increasingly she's just seen the benefits of really doing that self. Reflection and I am the common problem that I have to change and has done so much work with it. So I want to challenge you like I haven't already what would a veterinary hospital owned by Heather look like in 2024. Oh my gosh there are so many aspects of what this dream practice would look like but this is 100% empowerment the team carries the load. So we talk about efficiency doctors diagnosed prescribing do surgery the practice managers able to drive culture along with the owner great culture good leadership principles.

Host: We would have the credential technicians or veterinary nurses whatever it may be for our state at that time. Being able to carry out a majority of the patient care treatment plans client education. We would embody the telehealth aspect we embody all technology so that we can make it easy for our team to do business. We have so many inefficient technology things in veterinary medicine that slows what we can do to be efficient and provide good customer service. Let's put the technology in let's make it easy for people to want to do to deliver exceptional customer experience because it's fun. And we can be efficient that to me is the dream practice we all collaborate we all achieve goals together we are we do have profit sharing available for every team member and we challenge our team to continue investing in their education. When you go to CE you bring something back to the hospital that we implement we build on it we build our revenue sources and we create a really happy client base and I'll say that in my history when I was in practice. Highering people was my lowest skill because I didn't have to hire people I had a waiting list of people that wanted to come work for us that I was already able to see what their skills were or how they worked and I could pick from people that we're going to be the right seat on our bus and I didn't hire but maybe what's every two years. Absolutely where I would be again driving that I would have innovation and I would make it easy for clients to do business with us I would create phenomenal customer service that. I don't think we can end on a better point than that except I'm going to just say the floor is yours is there any other messaging.

Host: We are the better patient care we drive the more clients we can see and we get to work smarter not harder not be burned out we get to love what we do. I don't think we can end on a better point than that except I'm going to just say Heather get the floor is yours is there any other messaging that you would want to share to the audience about you know how to how to bring fun back to the veterinary profession because I think part of what you're saying is we need to bring fun back as well. We need to bring fun back and the people need to be empowered to bring the great things back to hospital. I am a client now in this industry and I can see when we're toxic and when we're inefficient and when we can't get our clients in and now I'm the client that is impacted because. You can't see my little girl that has a UTI and I have to wait for two months that's not acceptable for me as a professional in this industry it's not acceptable for any of our clients and no wonder. We don't care, no wonder they feel like we don't care, no wonder they feel like it's all about the money. And until we create an empowered team that can deliver exceptional service high standards that we're all collaborative we're all on the same page. And we can't keep you in the cycle where we can't keep people because and I and I should say people we can't keep our own team we can't attract our team we can't keep clients nor can we attract clients. It's a vicious downwards file that we have to fix and we as owners and leaders have to take responsibility for it. To continue to work with you and for you to help reach your aspirations not just personally but for the profession and you know I'm part of the Heather fan club so.

Host: Thank you Dr. Weinstein it's been a pleasure. Well thank you Heather for joining us today and talking to us about the veterinary practice team in 2024 and beyond. We appreciate it very much but I also want to take a moment to thank our listeners we appreciate each and every one of you we can't do it without you. I think the messaging you heard from Heather today should be shared for sure so if you like our podcast share it with your colleagues and friends on social media. Send them a text whatever it takes don't forget to leave us a review on your favorite podcast platform and your reviews will help us help other doctors and practice owners find us as well. Until next time keep striving for excellence and making a positive impact in the lives of your patients your team your pet parents and wishing you all an amazing week ahead. Thanks again Heather. Thank you very much.