We Have Issues Can We Find The Answers

Host: Welcome to the veterinary business podcaster ultimate resource for developing a successful veterinary practice in career. I'm Dr. Peter Weinstein, one of the co-hosts of the veterinary business podcaster and this podcast we bring insights and expertise from industry leading doctors, experts, and thought leaders. We cover a wide range of topics including practice management, marketing strategy, leadership development, veterinary business issues, HR best practices and much more. Whether you're a practicing veterinary, a practice owner, a practice manager, veterinary student, technician, credential technician, or somebody just who wants to be involved with the veterinary profession, this podcast is tailored to help you navigate unique challenges

Host: over to we have challenges. An opportunity for the business of veterinary medicine. Every listener of this podcast is welcome to visit the www.v veterinarybusiness.com for additional resources and tools to support your growth. And remember you can subscribe to our podcast and high tuned school of the place, Spotify and all of the popular podcast platforms. Today, I am excited to share time and speak with Dr. Michael Bailey, Michael is currently the medical director at I-DX and a boarded radiologist. And our topic today is we have issues, can we find the answers? Michael?

Host: Thank you for having me, this is going to be an interesting topic. I hope I can help find some of the answers. Well, as a radiologist, everything is in your imagination anyhow, right? Well, I've been told that when you apply for residency, they interview your kindergarten teacher to decide if you have the imagination to be a radiologist. Well, I could say it's when I was going through radiology back in the dark ages when we didn't have digital radiography, it was like a raw shock ink blood test thinking about it from that standpoint. It's just challenging, have to be able to jump into the radiograph and become one with the image.

Host: Well, this conversation that we're going to have today really started as a conversation over dinner in Atlantic City at a conference where we spent more time in photo than we had spent in all of the years before. And we got to learn a little bit about each other, but from a current standpoint, but we really never dove into the background of Dr. Bailey. And I know you live in Pittsburgh, but where did Dr. Bailey grow up and when did you recognize that you might want to become a veterinarian? You said we have a week, right? Yeah. Yeah.

Host: Yeah. I was born in Queens, New York, in Queens, general, and around three years of age, my parents decided they wanted to move my brother out of the city, so we moved to New Jersey, the pastoral scenes of New Jersey, which was quite a change, I could say. And grew up through high school in Hopewell, New Jersey, which is about 20 minutes north of Trenton, New Jersey, about 20 minutes south of Lemmington, New Jersey, and give you a little bit more triangulation about an hour and a half out of New York City, 45 minutes out of Philadelphia, and three hours from Washington, D.C., this is a reason they call it the Garden State, actually it is. And it's not for what the reason you would think, it's because of the number of truck

Host: gardens that people had selling vegetables on the side of the road and markets and whatnot. The most common crop, at least then, in New Jersey, was actually turf grass, even in New Jersey is very well known for tomatoes or tomatoes, depending on how you want to put it. So it is actually a very agricultural state, even though most people only see the turnpike and people say, yeah, I live off eggs at night. I didn't realize you were from Queens. I actually was born in Forest Hills and grew up in Nassau County. So we do go back, we've probably crossed paths in a stroller at some point in time. That's right.

Host: We've at least been on the same turf, yeah, the long-owned expressway, okay, so you're in New Jersey. You're going to high school, were you, were you bitten by the James Harriet bug or were you bitten by a dog or what got you interested? Yes, I would. I have been bitten by several dogs while I was growing up, but it was probably my fault not theirs. We won't put that on them. I'm trying to think of James Harriet, might have just been becoming a thing when I was in college, actually, but no, I knew by junior high school, I wanted to be a veterinarian.

Host: My college, my high school counselor told me, well, maybe you might do better as a carpenter or as a plumber, that's not what I wanted to do. We had, in my high school, we had two tracks, you could be academic track or you could be vocational track. And I did, by the way, I love carpentry and whatnot, but no, I wanted to go the academic track and I can say in all of the classes I was taking, I was probably the only African American in the class that I was taking. Never thought about it at the time, it just was another class, but most of the black folks who went to school with me were in the vocational track. I just refused that.

Host: So undergrad was where, Rutgers University, right, they're in New Brunswick. When I applied to Rutgers, I applied to the College of Agriculture, when I got my application, I got this application that said, Coach, and I said, I didn't apply to a culinary school. So I opened it up and it turned out they had changed the name from the College of Agriculture to cook college. So that's why the change there. Even though my diploma does say College of Agriculture and environmental science because that's technically what I applied to, we had a choice. So back in the era, which late 70s, early 80s, I'm gathering, yeah, late 70s for my high school in college.

Host: Right. New Jersey had very, did not have a veterinary school. They will have one shortly, which, on one hand, limited to you and the other hand, opened up all sorts of opportunities because I know that we in Illinois, where I was school had some contract seats from New Jersey, Cornell had some contract seats, pan probably did as well. But if I recall right, you didn't end up in veterinary school with any of those. I graduated from the historic Tuskegee University, very historic, a lot of history in history there. I'll be honest, that was the first time I ever was in the South, Tuskegee did have

Host: contract seats. And I actually worked on a number of committees, why was in veterinary, and undergrad, trying to get a veterinary school in New Jersey. And one of, I think it was the dean, told me, why do we want to have a school here with all the expense? When we get more people in veterinary school, then states that have veterinary school. And they were right at that time, there were 200 new Jersey residents in veterinary school at that time, you know, in all the different levels. So they were paying for those contracts. I did go to Tuskegee, that was the first time I'd ever gone to the deep South.

Host: That's another chapter right there, which you'd decide whether you want to dig into. But it was interesting because when I was down there for orientation, I had applied to several other schools, and I was put on the alternate list at University of Pennsylvania. And the admissions head from University of Pennsylvania was at Tuskegee, and he was talking to the admissions head from Tuskegee, and he's willing to told me this, the gentleman from U Pen said, what we have a really strong candidate we're looking at, probably we'll take him for next year, and Dr. Hall, who was that person asked, oh, who was he? He said, Michael Bailey, and he said, ah, he's in the front row down there. So you were a front row student, okay, I was a back row student, some of that is alphabetical isn't it?

Host: Yeah, I think at that time it was a result of alphabetical placement, and now I get down there because I like to give the lecture a hard time. So. And I'll vouch for that having had Michael in some of my lectures. So did you enter veterinary school with a commitment to become a board at radiologists? Because first of all, becoming board certified in any area is extremely challenging. It was even more so than I would suggest that as a person of color, there were not a lot of board certified specialists who had that background. So there has to be a story behind this story. When I went to veterinary school, I figured I would be a practitioner, most likely

Host: a small animal practitioner, but the veterinarian who I took animals to, and I spent some time with was actually a mixed animal practitioner. So that was on my mind. I did not know there was a such thing as a veterinary radiologist when I started veterinary school. The person who I just mentioned Dr. Ellis Hall, he was head of admissions. He also was the first black board certified radiologist in the country, the world. So he kind of was a mentor looking at him. I was, by the way, the third board, black board certified veterinary radiologist. Dr. Ruby Perry, who's currently in a test of he was the second.

Host: So it's a very short history of black board certified radiologist. I did my internship in residency at Michigan State. Michigan State was very forward thinking they really were out there looking for diversity in their programs. They felt it was vital. They were a diverse state and they wanted to find more people. So there were luckily a number of us who went to test ski in different programs. So there's a number of people who obtain their PhDs, number of people who obtain their residences. But when I did my internship, I was there trying everything out, like you're supposed

Host: to do in your internship. And there were two programs that caught my eye, internal medicine, particularly oncology and radiology. And I'll be honest, diagnosing things, understanding radiographs, how they work, the physics of it caught my attention. I also love the toys. I love X-ray machine. I love the ultrasound machine. When I did my residency, actually we were dual-borded. We obtained a diagnostic and a therapeutic certification at that time.

Host: So you did both. Now it's two separate tracks. So I really enjoyed the physics of radiation oncology, so I figured in radiology, I can combine my interest, love of oncology with the physics and radiologic diagnosis. And I'll be honest, being, I spent a lot of time in oncology during that period and I decided if I was a full-time oncologist, I don't know psychologically I could have handled because at that time they came into you in the diagnosis of oncology of an oncological disease. It was not a matter of, if it was just a matter of how soon. Yeah. Now that actually, during my, yeah, it actually changed during my residency.

Host: When I started, if you had, if a dog came in with osteosarcoma, you gave them a diagnosis of six weeks to six months by the end of my residency and when I was on faculty, we could change that diagnosis, get probably still, but you could get three years out of a large green dog because of cis platinum, that was developed at Michigan State. So oncology changed a whole lot, even during my residency, but still, I'm glad I picked radiology. So in your path from Queens to New Jersey to Tuskegee to Michigan State, as an African American, did you feel or face any challenges that made it a little bit more difficult? Were there roadblocks that you felt, putting in front of you, that you felt were unfair, did you have some of the challenges that I know and talking to Phil Nelson, who I speak

Host: to routinely, he had, but I think you're sharing some of the story and challenges that you may or may not have had could be beneficial to our listeners as well. I was an extremely fortunate child in that, in many cases, I was naive and my parents worked hard so that I did not feel the obvious pangs of discrimination, even though when I looked back on them, or when we actually talked about them, they were there, but they wanted me to try and live somewhat of a, I want to say, a sheltered existence. So what do I mean by that? I did not think about the fact that me being directed to go into a vocational path was racially based. I thought about that was what they thought I was strongest, but there could have been a

Host: little bit more to it. I was diagnosed as dyslexic, actually, my, who was a school teacher diagnosed me not my school system, so I had had some problems with my educational development, but once she told me what was going on, I found ways to get around them, but the educational system, which was an extremely good, I mean, my parents' weight made sure that we went to an extremely good school system. It was a public school system, but we had, in the 70s, we had access to mainframe computers in my high school and boy, that fire me off, but there were things that happened like, if I was walking down the road and variably a state cop would pull over and say, hey, what are you doing around here, kid?

Host: Oh, I live down the street, writing a bike, I bought a brand new swim bicycle. I had a state cop pull me over and ask me where I got the bike from, and there were other things like that, applying to go into certain programs or scholarships I was invariably, I got used to rejection letters. It sounds like your path has a lot more straight roads and long and windy roads, which is a good thing. I think we're in a state now of this profession that we are just focused on making sure everybody understands that we're in this together as a profession, and that we're working for the good of the animals and our clients and our patients and the profession from that standpoint. So I appreciate you sharing that story, but there's a story after Michigan State because

Host: when you graduate as a board certified radiologist back in that era, you really only had one choice from what I remember, which was to work in an academic setting. We didn't have everything we have in terms of options right now. So where did you go from Michigan State once you had your diplomacy? So that is a true statement you're making there. When we met, she was a registered nurse, she's now a nurse practitioner, but when I was looking in any opportunity, she would say, well, why are you looking there, I'd say, because that's where the veterinary schools are, which means it wasn't necessarily the best for her profession, but in order for me to have any growth, I had to look to see where there was an academic institution. I left Michigan State and went to the Ohio State University where I did

Host: become tenured faculty. That was a rougher existence, as I said, I was brought up in somewhat of a naivete when I entered into academic environment, believe me. I was woken up, slapped around and made sure I knew that for the grace of God was the reason I was there and keeping your place kid, probably as I could never stay in my place. So I left Michigan State to go to Ohio State because I wanted more challenges as far as a research background. I wanted to stay in radiology, but I wanted to find out more about the research aspects, writing grants, actually performing the research, and Ohio State was definitely the place to go for that. I found a lot of great people to work with, but the restrictions at the veterinary school, it was amazing. It's like they said, shoot for the star. Oh, and by the way, we've got an anchor on you. So you got to figure out how to carry that anchor with you. And what do I mean there? Well, first of all, you had the tea.

Host: Just fine. I like teaching. You have to do service, which means reading the films and whatnot. You have to do research. You have to publish, and I was actually told by the head of my division that I shouldn't be worried about my kids. Let my wife take care of the kids. My job was to do whatever I needed to do to get 10 years. And I looked and then said, well, my wife and I have a contract that says, we're at a 50-50 relationship, you know. So there were a lot of interesting things. Definitely, I'm going to say race based that we're throwing in my way. And I'm going to say it actually made me an angry individual in many respects. Wasn't good for me, wasn't good for them, but I was determined to get 10 years. I got 10 years. I made a lot of suggestions on how to improve things, suggestions completely ignored for whatever reasons they were. We won't go into that. And then I finally decided it wasn't a healthy environment. So after getting 10 years, I left that

Host: a name. Well, that's a rarity because once you have life without parole, it's hard to leave that, but also in that time there was the development of other options outside of the university setting. Yeah. And so that opens up so many different doors for radiologists that never existed 30, 20, 20, 30 years ago. Yeah, there's a couple of things that go along there. So that was one of things that let me know that I could do something other than being an academia. But remember I said, I love teaching. So that was why was that the university I started doing consultation with? And I found out that I could do it. I was good at it and was even more. I was learning things at the university never taught me. In other words, I could teach you the perfect way of doing a histogram, but it may not be the way you can accomplish it in a practice. So I learned those tricks how to be efficient, how to get the best study with what was

Host: available, how to talk to people, which is probably one of the biggest things that they don't teach you in veterinary school. They do not teach you in a residency. How do you talk with people? How do you talk with other colleagues? How do you talk with the client? How do you talk with the pet? All those things are so important. Those are things I learned outside of the university. And I found that I could thrive outside the university. However, the one thing which I did also find, I don't know if you know this, but Ohio, it's first licensed black veterinarian was licensed in 1960. And that's significant because without that individual doing that, it might have been more difficult for me to get licensed. But I was board certified and if I was not board certified, I probably would not have been able to do the consultation service that I did. There were several non-board certified surgeons in Ohio, in Columbus, actually, and it didn't matter. They were white.

Host: Being black, I needed to have that extra credential in order for people to take me seriously. No, it worked out very well. So Columbus, I'm glad I did it there. It sounds like that really was the first time you dealt with significant racial biases, but it probably, you know, what doesn't kill you makes you stronger, right? Right. And I'm going to say, it's probably not the first time I dealt with them. It's the first time I dealt with them, head on, recognizing what it was I was dealing with. Right. Oh, man, that opened up so many different doors, but where I want to go now is the present. So now that we've put a face to the signature, by the way, that came from a discussion, Michael and I were having before we started the recording, because many of you know, Michael Bailey with his signature from Idex, and you don't know what Michael Bailey looks like,

Host: sounds like, and feels like. So hopefully that gave you a little bit of a foundation. But I do want to talk about the current trends of radiology and talk about AI, which when you and I were veterinary schools, artificial insemination, and now AI is artificial intelligence. And one of the debates, for lack of a better way, to put it, is the impact of artificial intelligence on the reading of radiographs. And so I'm going to put you on a corner, in a corner, or on a pedestal, or wherever you want to go with this, and just say, talk to me about your thoughts of the benefits, downfall, where does AI fit in the current future world of radiology? Okay, first, think about this just little phrase from a movie where a robot said, hello Dave, 2001 Space Odyssey. That was probably most people's first introduction to the potential of artificial intelligence. And what did he do? He went rogue.

Host: Good reasons. He had a psychological breakdown caused by a human. But still, it comes down to artificial intelligence, if not treated with respect, can cause damage, which is true, even today. Where we're going with art, where we are with artificial intelligence is artificial intelligence has the potential to screen. I'm emphasizing that word, screen images. Screening means, okay, it's doing an evaluation, but a human should still be the one that makes the final decision. Artificial intelligence can write reports be aware that if you're using one of these new generative AI programs like chatGPT, they have what's called hallucinations, which is just what it is. It's not, they're saying something about something that's not really there. So what's it mean? They need to be modified, augment, they need to be supervised. That's the word I'm looking for by a human being. There are things that are out there that may make it so

Host: that they are self-supervising and what not. But if we're not careful, if we take the programs that are out there and use them like anything, you have a Tesla. Today they're saying they have to update the software in the Tesla because people are having accidents in them. Well, whatever I think about Tesla, they were not designed to be driven by themselves. They're designed to be driven with human supervision. So don't blame the machine if this machine is making the mistake. So we are going to be, in fact, you have probably been using artificial intelligence. If you have an an Android, if you have an iPhone, you have any computer, if you use Google, you've been using artificial intelligence for probably well over a decade. We just have to be sure that we're using it in a responsible fashion and it can improve. It can improve themselves, they can improve the quality of our existence. They can improve access to care. One of the ways they can improve

Host: access to care instead of you or I, having to weigh through all these lab tests when we're going to go in to talk to Mr. and Mrs. Jones about their pet. The artificial intelligence can be in there, ranking them, evaluating them, even making thought comments for you to think about. So by the time you get to that exam room door, you can say, Mr. and Mrs. Jones, here's our three top differentials and here's what we're going to do. And the computer has helped us to come up with these differentials just in that five minutes from walking to the lab where you may have hundreds of test results or even more trending is one of the best things. We had trending. Let's talk about a vertebral heart score for OBMP when you're doing a cardiac evaluation. If you can trend these, what was it two years ago? Last year, six months ago today and if you're seeing a trend where the heart's getting bigger or the probian p is going up, you can get a handle

Host: on what's happening before it's showing up clinically. We can't do that. Not because we couldn't go there and draw the trend lines, but it would take too long for us to do this while we're trying to move on to the next thing. So their computers are going to allow us to have things almost instantaneously compared to the fact that I was putting it off forever because we don't have the time to do it. That's what artificial intelligence is going to afford us. It's going to afford us quicker results and it's going to do those trends so that we can see them and evaluate them in reference to our patient. And that's going to allow us to have more time to deal with more patients. Yeah, the time side of things is huge. I do think that, you know, I've taught and written about efficiencies, but anything that can get us time back to do a better job in communication, do a better job in relationship building, and get us time back so at the end of the day

Host: we can get home and be with our families is all good. And I think it's important to emphasize the fact that technology should be an adjunct not a replacement for touchology. Right. I call AI augmented intelligence instead of artificial intelligence. And I have a person who I work with says he calls it the Iron Man model. Why? Because there's a human inside of that suit. Yeah. So we've been in this profession. We both been in this profession for a while and we've both been involved with organized veterinary medicine at different levels. Most of my involvement has been at the state and local level. I know you've been involved with the AVMA board for a period of time and now you're running for AVMA president. You know, president elect, which president. Yeah. So in a brief, how did you go from board and radiologists in dark room looking at films to a public figure in organized veterinary medicine? That path must have been interesting itself. Well,

Host: let me start off like many veterinarians. I'm an introvert first of all, which is contradictory to what we're talking about. Right. When I realized that I was an introvert, I sort of took a immersive therapy and I started taking voice lessons and singing opera. Okay. Time to demo. No, those are past days. Okay. No singing today. You have to be you're an athlete. If you're a singer, you're an athlete. And I'm hate to say it. I'm a reformed athlete. But the point saying that was I decided, you know, you can do things in five minute intervals and get yourself used. I decided, no, I didn't like the fact that I was afraid of facing people. So I jumped in feet first. I couldn't figure out anything that I could do that was probably more of a shock treatment than singing out in public in front of a full auditorium. Mind you, I never had. I did have a couple solos, but I was mainly in the chorus line, but still it's just the fact that

Host: you're out there looking at hundreds and one time thousands of people and realizing that they're looking at me on that stage. So I decided that when there's something that scares me, that's what I need to do. Then when it comes to, well, I've been in the universities, I lecture at universities and then internationally. When you're in academia, I'll be honest, this is a little bit of a disappointment, but many academic veterinarians do not get involved with AVMA. They may be members, but they don't get involved because they're time. As I mean, you heard me allude to at least the amount of time commitment to get tenured and such. So when I left the university, I looked around and said, you know, I want to know more about my profession. I want to contribute to my profession. And I suddenly realized there was nobody on the organized veterinary medicine side that looked like me. So I started, well, I guess back up just

Host: a little bit, I did a congressional fellowship on Capitol Hill. And once again, even on Capitol Hill, I realized there weren't a whole lot of people that looked like me and decided if I wanted to open up opportunities for others, I needed people to to see somebody like me, didn't have to be me, but I needed to have people see somebody like me. So I decided, I had to be an example. If that's what I thought needed, you don't go out there and scream, why aren't you doing? You go out there and say, I've got to do so you can see that this can be accomplished. And also there were things I felt I can contribute by being involved with organized veterinary medicine just for our profession and for our patients. So I became involved at the state level. First, as a county representative, then moved up into the Executive Committee, eventually I became president of Pennsylvania Veterinary Medical Association. I think it's the oldest association in the country, by the way,

Host: 1883 is what I want to think. But somebody wants to tell me I'm wrong, I'm not going to argue with you, but I think that's what it is. Then, after I finished my presidency on PBMA, they elect me to become an alternate delegate at ABMA, then after being there, there was an opportunity to run for district representative of district two and district two for those who may not know that involves its East Coast state. So it's New Jersey, Delaware, Maryland, Virginia, Pennsylvania, District of Columbia. So I ran for that, what district representative, district representative is the member of the board. So that is where I spent six years on the board of the ABMA and education in itself. The ABMA 163-year-old organization now, I was the first, I'm going to say African-American, because there's other people of color on the board. So I don't want to downplay them, but first African-American to be on the board of directors of the ABMA.

Host: And for that fact, I'm the first African-American even to run for President-elect of ABMA. I'm trying to show people, and when I say show people, you doesn't matter who you are, what you are. As long as you have an honest heart, you have a place you're needed on the ABMA. That's really what I want to say. You are needed. I want to get more people involved. Very few African-Americans are involved with ABMA, and for what people want to say, it's not African-Americans fault. We have not been invited to be part of the ABMA. African-Americans represent 1.2% of our profession. And with all these things with the rulings against desecrogation efforts and whatnot, this is killing our development of our country, because we need to have people from all different backgrounds. White, black, yellow, LGBTQ, whatever you may be, we need to have everybody represented because there's things that those individuals, whoever they may be, may know, may have experienced that if we do not

Host: and bring them in, help our environment to grow, because we are learning from them, it may be something we miss. Veteranarians have so much to contribute to this world, and diversity has so much to contribute to veterinary medicine, and people have to remember, veterinarians are vital for one health. And when I say we're vital for one health, that means we're vital for not just animal health, human health, but environmental health, which means we're responsible for the health of this world. So we need to know about everybody in this world, and for me to be the first African-American, even to be getting close, this means how much has been missed over these years. I don't realize how much has been contributed by immigrants, by people. You know that statue, and I forget the name of it, but sitting on top of the capital building in Washington, D.C., everybody gives is one person credit for, really, it was actually made possible by an African-American

Host: artisan, but nobody thinks about that. I mean the entire capital had contributions from slaves, but it was an artisan who figured out how to get that thing built and up there on the capital building. So yeah, I mean the work of the United States is a nation of immigrants. The Native Americans are now fewer and pushed away, and this is a country of immigrants who we really are a melting pot. And we need to ensure that this Goulash that we call a country is everybody's heard, everybody has a voice. Everybody contribute something. And if we ignore their contribution, people don't realize the large number of pharmaceuticals, which we have that have come from folklore or from witch doctors. It would just start with something like Belladana. That used to be a plant people used to just go out and pick. That was brought to attention by Native people saying, hey, when we're having these problems, this particular plant

Host: helps us in those problems. And I was reading an article the other day talking about in Africa, the number of plants that Africa, when it was colonized, the Colonials actually went out of their way to re-educate the witch doctors, so to speak, the wise people, from using all their colloquial medicines. And then they took the things that they were finding out about these medicines, and they went and they developed manufactured pharmaceuticals out of them. But they said, no, no, no, you can't use your plants because they're adulterated. They've been using them for centuries. If not millennia. I'm not saying that purified forms aren't significant advantages, but we don't degrade what they've been doing. We say, well, thank you very much. We learned so much from you. No, sorry, period. You say I get emotional about some of this. No, I appreciate the passion, and I think to be running for a position as President-elect,

Host: you have to have a passion for the profession, but I appreciate the passion that you have for the diversity of the profession and the need to bring that to the fore as well. And I'm sure that the issues that we're going to talk about in just a moment can get you passionate as well, because we do have a number of issues that this profession is dealing with, and they are issues that to seem to have cropped up and they show up out of nowhere and some disappear in some linger. But as a leader in the profession, I will ask you to, for your take on some of the issues that have been headline news, at least within the veterinary world, and let's start with workforce. And you are an academic, so you taught, and we know that there are concerns about workforce, and the workforce, in terms of the number of veterinarians, and I would suggest the number of credential technicians as well. There have been reports from both extremes. An AVMA has taken

Host: its position. What is your take and what is your platform as president-elect candidate when it comes to the workforce issues? It may not align with the AVMAs. Here's the thing, if you have a healthy profession, a vital profession, you never have enough people in the workforce. If you have a healthy professional leadership, they are always trying to expand the footprint of the profession, which means you're always going to need more and more and more people in the profession. If you look at human needs, human needs are always to be in certain geographies, which means that people or the most part are going to congregate in sit towns, villages, cities, which means there's always going to be a peripheral area, which does not have a service. So, the workforce issues that we are addressing are not going to be resolved by saying, okay, here's the high water market, we're not going to go above that, because if you do,

Host: you're not figuring out the fact that, first of all, the people that you may be excluding, maybe the ones who are willing to go to those outer areas. Also, as soon as you start putting a high water mark on something, then you're not ready for the next time that there's a big surge. So, I know we have two extremes, one thing that we are going to have a huge shortage of veterinarians we already do, but it's going to get worse. And by the way, we may have as many as 12 veterinary schools opening here. We already have a shortage of 400 faculty for the existing veterinary schools. So, where are we getting the faculty for those 12 veterinary schools? But if we are going to put a limit on there, we aren't going to have, we'll start growing and then all the sun people will say, oh, you need to close some schools, because we don't have places for all these people to go. My feeling is that veterinarians should always be looking to see what is the next

Host: great opportunity. I think we need to be sure that everybody understand, well, everybody understands that not everybody is going to want to be the family pet animal doctor. Whatever that may mean, that may be whether you're a general practitioner, that may be that you're in advanced practitioner, that may mean that you're a board certified radiologist. There's people who are not interested in that. And if they think about veterinary medicine as being only that, they'll never apply. The first FDA approved surgical robot was designed by a veterinarian. He built, he designed, he got it patented by a veterinarian. There's so many things I could tell you that veterinarians have done first, but people just assume, oh, it was medical science. Medical science cannot delve without us. We've had veterinarians who have been on the international space station. We have veterinarians that are going to be vital on the moon and on Mars.

Host: People say, well, what's a veterinarian going to do? Well, we aren't going to have cows, but we may still have a herd of petri-dish protein that needs to be monitored and improved and diagnosed. And once again, veterinarians are the best adapted in order to go to these outer regions. And that's not saying that we don't need as many veterinarians as possible down here, taking care of, yes, pet animals. But remember, we also have food security here in the planet. We, if you look at the military, we have some of the greatest MDs, orthopedic surgeons and whatnot in the military, but it's veterinarians who make sure that the service personnel are healthy. So when they're called upon to do whatever job it is, they know that they are ready, because their food supply is secure. Their environment is healthy. They're breathing clean air. Anything that is in environmental health probably has a veterinarian involved. So we need

Host: people to know that you can be a veterinarian and low and behold, I never want to think about it, but you may never have to put your hand on a furry beast and still have a vital veterinarian. So we have that issue. And the next issue I want to bring up is something that you have been involved with because it's what radiologists do to agree do right now. And that's telemedicine. Yes, 1987. So when I started, right? So it's been part of the veterinary profession for 35 years, 36 years, sorry. And it's been done more on the business to business side. In other words, specialists to generalists, side for specialists, specialists, or generalists to generalists. But now we're looking at telehealth between business and consumer, B to C, between veterinary practice. And the biggest debate that seems to be out there and the only really thing that I can identify that has created consternation is, well, there are two things. One is how do we charge for it.

Host: But two, the concept of a virtual VCPR, the concept of establishing a veterinary client, patient relationship without a hands-on hand touch the pet, physical examination. Any, let's just make this a two-part question. Your thoughts on telehealth, telemedicine, tele whatever it is, and then your thoughts on the VCPR relative to that. Well, I'd be a hypocrite if I said the telemedicine was bad. What a nice. Yes, you would, but I was interested to see if you would take that chance. No, I believe in telemedicine. I believe in telehealth. I am also cautious in how it's practiced. I have a thought, something which I'm thinking about, how I can accomplish this for everybody who wants to establish telehealth, however, without there being a physical client patient relationship. I'm thinking about, can I make a stuffed animal? And yes, I can make a stuffed animal. I can go to beers down here and have one made up. But as somebody like you, can you tell me everything

Host: about this animal just by looking at it? And then some people will say, yes, and some people will say, no, and then let's say, well, here, I'm going to have somebody hand you a copy of this animal, and you put your hands on it and say, okay, palpate it. And what I want to do is put a firm object inside the belly of this stuffed toy and say, do you feel that firm object? Can you tell me from telemedicine that there's a firm object inside of that stuffed toy? I think that's that says everything right there. You do not have to have a physical examination every time you're doing telemedicine, but I think on a regular basis, there should be one whenever possible. Does that mean every single time? No, if you are living in Guam, and actually I met a student of mine who's practicing on Guam right now, but they may not be able to get to you. So you do the best you can, but whenever possible, I'd say, yeah, this is something we need to do today, but you know,

Host: in the next couple of weeks, I'd like you to come in and either see myself or one of my associates, just so we can do a complete physical exam. I think individuals that are trying to eliminate, completely eliminate VCPR with a physical VCPR, I think, are putting our patients at risk. But in order for us to say, no, you can't do that at all. You're also putting our patients at risk. Yeah, the future is interesting. I'm both those topics that we've talked about. As you know, from an article that I've written for ADMA and some of the work I've done with the economics division that I'm very strong advocate of team utilization and addressing efficiency. One of those areas that needs to be addressed is the discussion of credential technicians and the fact that we've got 50 states with 50 practice acts, all of who address credential technicians differently in terms of how they're defined or in some cases, not even defined and what they can or cannot do, which then

Host: impacts what a veterinarian must or must not do as a licensed veterinarian. How can we help increase title protection for credential technicians? How can we increase a better definition for technicians globally and start to break down some of this confusion that currently exists among with regard to tech utilization? Because to me, tech utilization could slow down some of the needs on the workforce issues if we learn how to delegate to skilled credentialed resources. Right. Veterinary technicians are a vital resource, but they stay in the workforce three and a half to five and a half years, which means that we can't keep up with the attrition. We need to we veterinarians need to use technicians to their maximal training. We also need to be sure, however, one of the biggest problems is it's more of a political and even commercial problem. We need to have standards so that everybody knows if you are a licensed credentialed veterinary technician, veterinary

Host: nurse, depending on what state you're in, that we know you have the capabilities of doing these things and not everybody can do everything. We understand this variations, but that's also part of our educational system. We need to improve our educational system overall. We've been doing education, whether for a veterinarian or for a technician the same way for 50 years, maybe longer. No, we have so many more. We need to improve that system so that they can come out. We know what they have. We need all the states to establish a similar standard so that we know if somebody says that they are a licensed or a credential veterinary technician, we're comfortable. Oh, they are. It's like there are five million registered nurses in this country. If you say you're a registered nurse, nobody questions what your skills are. They say, oh, okay, we need you over here. There's people, if you say, I'm a licensed veterinary technician, they say, what's that?

Host: What can you do? I'm not sure what you can do. So that's a bureaucratic problem and shame on us for not having taken care of this years ago. I don't know if I'm giving you an answer there. No, you did, because I'm on board with you completely. I think that we give it's interesting. We have a national test for technicians, the VTNA. We have a national test for veterinarians, and we've done a pretty good job of defining what veterinarians can do. And it's really three things, diagnose, prescribe, and do surgery. And in some states, you have to do a rabies vaccination, but we can't seem to clearly define what credential technicians can do in all states. And I think that's part of the challenge of the life expectancy being five years. I mean, we don't create careers for technicians. We create jobs. And that's doing us and them a disservice as well. And we could spend an entire hour just talking on that, but I appreciate your insights on that, because I do think

Host: it's an area that needs improvement. And I think AVMA and NAFTA have to lead the way on this and get the state boards to stop sleeping on it, for my standpoint. They need to become enlightened. Exactly, absolutely. So you mentioned earlier that your wife is a nurse and then became a nurse practitioner. Now, we have a discussion about nurse practitioners in the veterinary field, but we're calling them kind of mid-level practitioners. And so here is an effort to create a new title within the field that would be a little bit of a credential technician on steroids. Yes, so no. First of all, I started having that discussion with my wife to get her point of view. And I said, I first started off saying, do you consider yourself a mid-level practitioner? And I'll be honest, the steer I got from her could have frozen the North Pole. Sorry, isn't it? The reason is she told me she's an advanced level practitioner.

Host: Yeah, okay. So she's not a mid-level practitioner. We do have various levels and you could say that the veterinary technician is already a mid-level practitioner, but if we want to go one step further, we have veterinary technician specialists, which are definitely at a mid-level practitioner level. But once again, we're not utilizing them. So they're trying to make a new position, folks, we already have it. If we go to make a new position, all we're going to do is we're going to parasitize what we already have without giving those individuals the opportunity to perform up to what they do. And by the way, most of the technicians I talk to that are leaving our profession are becoming registered nurses. Yeah, the VTS is one of the best kept secrets of the credential technicians out there, and they have the VTS's in private in general practice. And they have been radiology, and they have them in emergency and critical care,

Host: and we haven't given them the respect that they deserve. And so if we don't use our credential technicians to the top of their job description, and we don't use our VTS's to the top of their job description, why do we need to create a new job description? Why don't we just start working with our people that we already have? Right. So what we're saying by saying we want to make a new position is I'm sorry what we're saying is we want to scrap the positions we already have it. And that's I'm sorry that's not acceptable. So you mentioned a number of times veterinary education. I loved when you talked about the veterinary schools don't teach residents how to talk to people. And if they don't teach residents how to talk to people, are they teaching veterinary students how to talk to people? Because I have there are very rare cases when an animal isn't related to a person that you have to talk to. And so I think that we are very good at the

Host: IQ components of being a veterinarian, and you mentioned it yourself as an introvert, but we're not as good with the EQ components of being a veterinarian. So when it comes to veterinary education, what do you see some of the challenges are with the current number of schools? We'll talk about the 11 to 12 new ones in just a moment. But what would you suggest to the deans of the veterinary school to help address the workforce issues, but maybe to address the workforce issues with the skill sets of the graduating veterinarians? Some of the newer schools, and I saw this at the Midwestern University in Arizona, they actually have simulation rooms. So they actually put students in there with actors, and they work out different scenarios. And I won't go into detail with the scenarios, but I've been told they could be some rather challenging scenarios. And the idea is put the student in the situation so they're developing a muscle memory. So

Host: when they encounter this out in practice, it won't be the first time, at least they've had some sort of training, all the veterinary schools should be doing that. The other thing is we don't even have to go as far as making rooms with the new immersive technologies, and this goes across the board. You can put a person in a simulation, which seems so real, and whether it's interacting with a client, it could be the fact that they're doing the first spay, and they're doing the incision, and all of a sudden they've sliced something, and you hear, oh, so they can go through the simulation every parent, or at least recognizing that the mistake, or they like-aided a eritor, so they recognize that was the wrong thing to like-a. Even there, we have a significant drop in the number of males that are entering veterinary school. Do you know one of the reasons that may be I don't have statistics on this, but one in 20 males is colorblind. Many of them

Host: do not know that they are colorblind because the schools no longer test them, and I went through school, we actually had a test, and when I took a few minutes to see what our color accuracy was, they don't do that anymore. So there's many people entering college, and maybe even professional school, not realizing their colorblind, and there was a simulation, which I was shown where they had a videotape made by the school, and they were practicing suture patterns, they were saying how to tie this particular suture pattern, and they had a blue thread and a red thread, and they said, place the blue thread over the red thread and whatnot, and one of the students said, which one is blue? Which one is red? They couldn't see it, and they had not known, and they'll be put until being put in that situation, that they couldn't recognize colors. Now, they may not feel comfortable telling people, I can't tell what these colors are here.

Host: There's something wrong with your monitor, I can't see the colors, so my listen, the monitor is working fine. Depending on who you are, particularly if you're a minority, by the way, you may just decide to shut up because you don't want people to know that there's something wrong, especially you don't know what's wrong. Interesting. I think that there is a need for new education, you talked about the fact that we've been doing things the same way for 50 years, and it'll be interesting to see how the new veterinary schools that are on the docket, 12 of them, or so, if I've heard as many as 15, will identify ways to teach differently when, as we both know, there is already a shortage of academicians in the current pool of veterinary schools. So, do you think that more veterinary schools is a solution to some of the workforce issues? And if so, do you think that if you think it's important that they just don't do the same old

Host: same old, if let me put it this way, if you are opening a veterinary school, and you're going to be the dean in 2026, what would you do differently? Well, first of all, if it comes down to, do I think more veterinary schools to the answer? Nobody ever wants to say, no, you can't open your veterinary schools, I think you're redundant. But let's go, do we have too many cars on the road? Where I live? Well, yeah, it was out there for the first time, so I could understand that. But we have to ask us what we're trying to solve. So, let's say what we're trying to solve is a pollution issue, but nobody wants to give up their car. So, what you do is you try to make the cars more efficient. So, first thing we need to do is make the existing vehicles or replace them with that more of a more efficient. Then the next thing is say, you know, we can make things more efficient by redesigning how people get from point A to point B. So, in that case, you may go to a

Host: high speed train, which everybody goes into instead of cars, which, so you see what I'm saying is if you're doing the same thing over and over and over again, that's the definition of crazy. So, why are we trying to be crazy? Now, doing need more veterinary schools today, I'm going to say there's a reason for it. But if we were to redesign some of our older veterinary schools, we might be able to make it so that those veterinary schools can be more efficient and would be equivalent to one or two or three of those new schools that are going to open up. So, instead of 12, maybe we only need eight. But once again, I'm not so much concerned about the number of veterinarians that are coming out. I want those veterinarians to be ready for what they're going to face when they do come out. Quality control and understanding, because the economics of the professional, which is the next topic is, is interesting and it's challenging, because if you look at the statistics over the

Host: last year and a half since kind of the end of COVID, if there really isn't end, we've seen veterinary visits down. The number, the amount that people are willing to spend is stagnant or down. We know that we're living in an inflationary environment that's kind of flattened out, but we've got the cost of a recession in front of us. And one of the biggest issues, one of the greatest discussions is the cost of care. And if we are setting up barriers for care to clients because of cost, because of the increasing salaries, because of the increasing salaries for veterinarians, increasing salaries for staff, the supply chain costs are going up. We have started to put a cost as a gatekeeper, not knowledge as a gatekeeper when it comes to clients. And that biggest gatekeeper comes with lower income people. Well, right now lower income people when it comes to veterinary services are middle class and below, or maybe even middle middle class and below.

Host: So the economics of the veterinary profession are extremely intriguing at the moment as to where we're going to go. Do you have any thoughts, opinions, concepts about this cost of care, access to care, and then the terminology spectrum of care, all of which are becoming more and more headline newsy when it comes to the veterinary profession? Okay, we just change into Bloomberg or it's CNBC or something. Exactly. Yeah, I have seen the numbers also that say that the number of invoices are going down and the words a practice may maintain its revenue numbers, they're maintaining them by increasing the value of each one of those invoices. However, I've also looked at some economic numbers and this is from Morgan Stanley who actually evaluates the pet care market. And they say over the next 10 years, the pet health or pet care market, they're not quite the same but they're all grouped in the same is going to go up on an average of 8% per year. So in other words,

Host: the market is not going to go down. It's just a question where people are shifting their dollars in that market. Okay, so in doing that part of that's going to come down to the change of the pandemic and the corona. So people are not home as much. So they may have to spend more money in putting phyto in puppy daycare. They may not be home to see when phyto is student is or her but so visits may be going down just due to a behavioral change. But at the same time, I do agree that they're looking at what their veterinary bills cost to them and they're saying, hmm, I don't know if I can afford that but then again, Amazon giving me this great deal on a new pet bed. So if they save money on the veterinary bill, they can buy the pet bed. We have to become attractive just like the new pet bed. Part of that is where telehealth does come in. We can monetize telehealth. I don't know why everybody says, and maybe I'm the naive veterinary radiologist has spent

Host: his formative years in a dark room, smelling chemicals. I no longer sit in a dark room all day long and I no longer smell chemicals. But I would say that there's ways of monetizing telehealth so that there's advantages and people will pick up their veterinary visits. For example, if you do a spay or a neuter, you give a odor, a certificate, or a telehealth visit. And if they have a potential problem, you've already seen the patient, you've examined the patients, they are in a stylish patient in your hospital. But if they have a question or a problem, let's say the incision is inflamed, they cash in, they're telehealth certificate, and they get a visit with you. And you put on there, this is worth, let's say it's worth $25, $50, whatever you feel you want to monetize it as. And if they use it, they cash it in, and you'd sell, know that's typical healing. Yes, it's a little inflamed, but I tell you what, why don't you stop in the hospital tomorrow

Host: and one of our associates will take a look at you, or know you should go to urgent care, or ER tonight, or even better yet, somebody's going to be here waiting for you to come in. So in other words, there's ways of addressing it. If they don't use it, when they come into their next visit, they have their telehealth, I didn't use my telehealth certificate. Why tell you up? We're going to cash that in towards today's appointment. People hate losing the value of their coupons. So it's a golden handcuff. So that's a way of monetizing telehealth. So if people need it, they have it. And the fact that you said, no, you don't need to come in tonight, you can come into tomorrow, or you can, this is all fine. They're going to feel so much my veterinary team, I'm emphasizing team, because it may not be you, it may be your veterinary technician who talked with them, but they felt that they had somebody there who was listening

Host: to them when they needed them. But if not, they're using their certificate next time they go in, so they're going in and for their six months check or whatever. So we've just spent a good deal of time talking about six or seven issues within the veterinary profession. I'm sure there are others that I haven't covered. Is there anything in your platforms or thoughts or ideas or messaging regarding your interest as President-elect that you would like to share that you haven't had a chance to share. This podcast is part of it. One of my talking about communication is a large demand. You've already heard me talk about that. We're not very well-trained communication and veterinary medicine. We need AVMA needs to be out there communicating every day with the significance of veterinary medicine. We need to communicate to those kids around six grade level as to why veterinary medicine is the place to be. If you want to play computer

Host: games, come on and play computer games. We'll teach you how to do it with a robot. We need to communicate with our clients and other individuals in the general public about what veterinary medicine does for them. People need to know that it's veterinarians that identified West Nile disease. It wasn't the human medical system. It was the veterinary health care system that identified it. And the significance there is an encephalitis in New York which nobody in the human health care arena had any idea. And they actually were turning their backs in us when we tried saying, we got it right here. But luckily a strong veterinary pathologist made sure that the word got out that we had a novel virus in the United States. And then we need to communicate with our colleagues. And when I mean by our colleagues, I'm not just talking about other veterinarians or veterinary specialist or veterinary technicians. I mean those in the human health care arena

Host: and remind them that we are part of the healthcare team. We're veterinarians but we are part of the healthcare team. And we need to communicate this all the way up to the politicians. So when politicians are trying to do something and say, well, I'm going to regulate so that veterinarians have to do X, Y, Z that they understand fine, you do that and you're having an detrimental effect on healthcare out there period. We heard me talk about education. AVMA, I feel, does need to get more involved in education. And mind you, the AVMA board has a firewall between it and the council and education. But there's still things that can be done, saying, we need to modernize so we can work with organizations like the American Association, Veterinary Medical College, isn't talking about how are we going to design the new healthcare system so we're optimizing. So if we can take some cars off the road or make the cars more efficient, how are we going to make it so we're

Host: going to do it better. And we need to be out there so that everybody knows that veterinarians are the pre-mear one health care team out there and without us, if you don't get the resources we need for our veterinary schools, for our students, for our respect, that it's going to affect overall one health. Well, I think, you know, normally I'd ask about where do you see your future, but I think you've shared where you see the profession's future. And I think if you have your brothers and can impact the crystal ball in the future, it would be President Michael Bailey at some point in time. And so I think with that Dr. Bailey, I want to thank you very much for your time for your insights, for your candor, and most importantly for your passion. As we talked about with regard to the veterinary profession, we have issues, can we find the answers? Thank you so much, we appreciate and I appreciate your time and your candor. And I look forward to having

Host: a dinner with you again in the future sometime in continuing our conversations. Thank you for having me. This has been an enjoyable conversation. I hope my energy didn't melt anybody's monitors. Well, I just take them over to also thank our listeners. We appreciate each and every one of you. We can't do what we do without you. If you like our podcast, share it with your colleagues, share it with your friends, share it on social media, take the passion that you heard and share with others. Don't forget to leave us a review on your favorite podcast platform because those reviews will help escalate people who are looking to find us and share additional information. Until next time, keep striving for excellence and making a positive impact in the lives of your patients, your team and your pet parents, and I wish all of you an amazing week that hit. I'm Dr. Peter Weinstein. Thank you very much.