How To Attract And Retain Top Veterinary Talent

Host: Everyone and welcome to the veterinary business podcast, your ultimate resource for developing a successful veterinary practice in career. I am Dr. Peter Weinstein, one of the co-hosts of the veterinary business podcast. On this podcast, we bring you insights and expertise from industry leading doctors, experts, and thought leaders. We cover a wide range of topics, including practice management, marketing strategies, leadership development, HR practices, and yada yada yada. Whether you're practicing veterinary to practice owner or practice manager, you, or even a student studying to be a veterinary, this podcast is tailored to help you navigate the various challenges and opportunities. Let's focus on opportunities in the business of veterinary medicine. Every listener of this podcast is welcome to visit the www. veterinarythusinessinstitute.com for additional resources and tools to support your growth and remember you can subscribe to the podcast on iTunes, Google, Spotify, and whatever you

Host: use as your podcast platform. Today, drumroll, I am excited to welcome back Dr. Cody Creelman Veterinary. Isn't that on? Not Geo, or Animal Planet, Dr. Cody Creelman Veterinary. YouTube or CEO offend that Cody and I had a wonderful conversation, not that long ago. So our topic today is, well, welcome back Cody. So let's jump in and it's great to have you again to continue our conversation. For those people who didn't listen to our first chat, what I should give the 35,000 foot overview of who is Dr. Cody Creelman. A farm boy, turn veterinarian who is passionate about the industry, spend a decade as a cow vet and now I'm having fun doing everything else. Well, you're no longer milking cows, so if you're probably a little bit warmer because if I remember right, you are from some northern part of a province that sees more snow and more darkness and sunlight, so it's probably nice to be in Calgary. So here we are, it's early in 2024. Are you one of

Host: those people who said New Year's resolutions and if so, what do you anticipate in the coming year, both for you and your family? And yes. So no, I'm not typically a resolutioner. It's not something that I think too much about, but I did sit down with one of my clinic's practice leaders recently and we just kind of were having an impromptu conversation about the year to come. You know, we're still focused on growing our newest clinic to try to get it to capacity, you know, in a sustainable but rapid way and then optimization of our mature hospital and discussing like, what does that mean? What does that mean? What does that term actually mean? When are we done? And of course, you're never truly done optimizing, but there's times when you're pushing on the accelerator as a practice leader and pushing on the break and, you know, it's a balancing act. You can't just keep the pedal to the metal constantly on your veterinary

Host: teams and cracking the whips saying, optimize, optimize, optimize, if they don't know where they're going, right? So you'll run them right into the ground. So we were discussing that as to, you know, what is our practice, you know, goal with with optimization. And at the end, we kind of just hoped that maybe 2024 we could have a couple week period where we felt bored eventually. So I'm not sure where that will come. I haven't felt bored for many years at this point, but it would be nice. I'd feel like in 2024 to have a period of time where where I can take a breath because it's yeah, it's, it's never ending. It's always really, really, really hard. And I would love, I would love to hear your perspective because I think also in the greater scheme of things, something that's, you know, top of mind is just like the industry as a whole is experiencing a little bit of hardship right now, too. I don't know how much you've talked about this or you've

Host: had conversations, but it seems like there's a lot of practices that are having a hard time filling their books, you know, growth is down, profitability is down. It's kind of, it seems like maybe right now as we're sitting here, it's one of those hard times in veterinary medicine. This is what I'm hearing from, from a lot of practice owners, locally and, and a far, I'm sure you've lived through one or two of these. It kind of sucks. My, you know, my mature practice, we were down $80,000 in December, you feel that. So, lots of stuff in that, thanks for vomiting all over me. Let me try to figure out what to address first. One of the things is, is you, you basically like to find some time to be bored. Maybe I don't know about like felt like I'm craving some sort of some sort of break at some point. Well, maybe it's balanced and rather than bored because you spend a great deal of time both working in your business

Host: and time working on your business, and it's really hard to find time to work on yourself when you're doing both. And so, you may have to make a personal decision that says, let's tap the brakes. You know, you were talking about running the engine too fast. Well, maybe every once in a while, you need to tap the brakes and say, listen, we're going to take, uh, we're going to make today an 80% day, not 100% day, or we're going to take and close on Friday Saturday and Sunday in this time, just for recovery. So you, you're the navigator and the captain of the ship. So you ultimately determine, and I know you have the direction, which is your vision, but you also determine how you're going to get there in the most direct path. So I'm going to suggest to you that one of the things you should think about is maybe you give your team a paid three-day weekend, and you do the same, and enjoy it. So that sounds wonderful when you're, but when you're in it,

Host: and you're feeling the pressures of everything else, you know, running a hospital, you know, in this economic situation, it's pretty hard. Payroll every two weeks, looming. That's an all-in-compassing sickening feeling. The thought of digging three, three days off, you know, my mature practice is seven days a week. Yeah, we could do that, but what are we going to do for payroll? Yeah, well, and again, that addresses one of the other issues you brought up, which is the hardship of things. The colleague friend of mine who I'm working with uses the acronym SOP, not for standard operating procedure, but for systemize, optimize, and profitize. So the systems allow you to work on your business and deliver the optimal experience, which ultimately delivers the profit. Now, that's running the business, and hopefully getting the engine to be, well, I know Tesla hasn't exactly been the best model for a self-running car, but that's really

Host: correct me if I'm wrong, in a perfect world, then that is on autopilot, and you're not quite there yet. No, absolutely no. Didn't that, you know, that's a function of my own choice for building another clinic and another clinic, right? It would be on autopilot if it was just one clinic. It's the things that I pile on top of work. We're currently building out in Equine Hospital. You know, that's where resources are going right now to build a new genealogy and Equine Medicine Hospital that launches in March, so then you feel like you've got to keep the pedal to the metal, so you can get that paid for, and you know, they're all all of that is by my own doing for sure. Yeah, so you're a massacist, like many of us, from that standpoint. But the practices themselves are not quite into autopilot yet. Let's talk about small animal clinical practices, and they're not on autopilot yet, and that's part of it because you've got all of these things

Host: that still need to be manipulated while you're doing other things that are just getting started. So you're really the chef in the kitchen with all of these different meals being cooked by yourself without a sous chef or without waiters and waitresses. So you're really running the restaurant as a solo restaurant in many ways. Yeah, maybe I guess to some extent, you know, with that analogy, I have amazing practice leaders, amazing leaders throughout the, you know, the rest of the team. So yes, I have, I have a lot of help. I'm very grateful to have that, but as the only person where, who has it all on the line, for sure, right? It's, there's no other, and I prefer that because I'm my best self when I'm doing that, right? I'm able to not check responsibility to work my most efficient to work my hardest when it's all on me. But that's hard. That's hard to do. Well, you're, you're your best friend and you're worse than in the all at the same time,

Host: aren't you? Sure, absolutely. So let's talk about the current economic environment that you mentioned as well. I'm not sure we're slowing down as much as normalizing, and we've had a conversation where we talked about the impact of COVID and getting everybody ramped up. I mean, everybody was running their engine in the red, so to speak. If we had gone through normal growth since 2020, instead of the escalated growth, would we be saying that we're slowing down, or would we be saying, well, this is just the way it's been for the last three, five, ten years, because I think what many practices are feeling is that now the car is starting to normalize. It's not running as hot, but we're so used to having been running hot, that it's strange to not be super busy. So it's super busy. The right method is somewhat busy, the right method, or is not busy, not busy is never the right method. But are we normalizing back to where we were in 2020, or are we really

Host: starting to take and slip backwards to an economic situation that is of concern? Because we do know nationally in the United States, I haven't seen a lot of Canadian numbers, but the number of transactions has been slipping for the last two years. Revenue continues to climb, most likely built upon fee increases, not seeing more people. And revenues up, transactions are down, and concurrently profitability is down, because the cost of payroll has gone up significantly in the cost of goods has got up significantly. So are we truly seeing a decrease in people? Are people saying no to our estimates more often, is this an economic or is it a normalization? Is it, is it, are we writing the ship back to where it should have been, or are we dealing with a greater crisis? And I don't have an answer for that, but I'd love your take on it. Yeah. Well, definitely you could draw a straight line across from where the trajectory we were

Host: heading on, take out in 2019, take out the boom part, and then draw that ruler on an average growth level, and that's exactly where we're at, right? So there was boom up, down, perfectly on track again. Where is the, I guess my concern is, where is the profitability edge right now for these practices and what adjustments are going to have to be made, right? You know, you can objectively look at, okay, so maybe we shouldn't be running as hot as we were, but if we've designed our systems to be running on with our support staff, with our payroll, with our biggest expense, with the number of veterinarians we have in the clinic, when we're looking at all of that, that profitability is not there, then we're going to have to figure out where we're going to go from there. And that's one concern that I have just as a lover of the profession is, are we going to see some pretty significant layoffs coming forward, and maybe I don't know.

Host: Is this, is a more expensive to run in this environment for sure? We've had to do some pretty significant cost of the living increases. I know, you know, the interest on my bank loans are pretty pretty steep right now. Everybody who has, you know, has been leveraged is feeling that. So all that money is kind of just going, going that direction. So what corrections are going to have to be made? What has our forefathers done in the past? You know, what did it look like in a way? What did it look like, you know, in the in the late 80s? It's, yeah, it's interesting to watch. I think that it is a new normal. I think people are still spending money on their pets. I think they're foregoing some, some wellness stuff. I think they're still paying for sick. The fee increase that's an interesting conversation too, right? Like, this is all I do all day long. And sometimes I look at at the fees and I'm scratching my head.

Host: I don't know what to think of them, right? You look at the fees that human medicine is charging for the, some of the same things that we're doing. You know, we're, we're 1% of the cost of that. But when you look at how much veterinary fees have increased over the decade, yeah, who's there in the ship? Well, veterinary inflation is higher than pet product inflation, which is higher than the consumer price index. So our fees have gone up at a much higher rate than other pet related and also other businesses from that standpoint. And a lot of that has to do with the significant escalation in salaries that occurred. And then, of course, the cost of goods being. But what, what happens is the responses as you increase your fees. Now, during the pandemic, people had liquid income. They weren't taking vacations and they weren't going anywhere. And so there was, there was some cash. Now that things have normalized, having been on enough airplanes

Host: and hotels recently, there are people outspending money. And so now the money that they might have spent on their pet is being balanced with other spend. And so I do think we're dealing with pushback from that standpoint. And also an inflationary world that pet owners are beginning to become resistant to. It's hard. I mean, I have a dog. I don't own a veterinary hospital. So I pay for veterinary care. And it's not inexpensive. But there's a very large population. And I'm sure it's the same in Alberta as it is in Los Angeles, of pet owners who love their pet. But can't afford the $6,000 cruise ship or can't afford $3,500 overnight hospitalization. And so do those rates reflect just inflation? Do they reflect veterinary care? And we have to recognize, and I think we've talked about this. But we have to recognize that veterinary medicine is a service industry. And we are competing for the discretionary dollars of pet owners that include vacations

Host: and air Jordans, et cetera. And so what's going to happen as pet owners start to push back more and more, how are we going to be able to take care of the average pet owners pet as we continue to increase prices and pet owners push back? I mean, that's what I think is going on right now is we've reacted appropriately to our costs, but not to our clients. How would you like to see me as a member of the profession and an owner of a practice? And the veterinary medical provider of 12,000 people in my community, how should I approach my fees and my fee increases and my fee decreases? Yeah, I mean, it's a great question. And some of it is based upon expenses, some of it's based upon efficiencies. I do think we have a relatively inefficient business model and we've talked about how can we utilize our technicians to the ultimate degree, to maybe provide lower cost services to our clients. Well, this service is for example, and allow the doctors to

Host: do the medically based services. So that pet owners don't have a $400 well, it's visit. They have $140 well, this visit. I think it's it's really interesting because we have huge overheads too. I mean, I have not seen your facility, but you've got huge overheads that you're paying for. And so you have to look at the efficient utilization of your space. Is it always generating income? Because any place it's not generating income, you're losing money. If you're not in surgery right now and your surgery is empty, it's not generating income, but you're still paying for it. Same thing with your lab, same thing with radiology. So fortunately, you've got a multi-doctor facility, but think of the single doctor practices that are in 2000 square feet, and all they're using as an exam room, or treatment, or surgery, and they have to pay for 100% of their physical plant. You also have inventory that's sitting around collecting dust. And if it's not turning,

Host: it's burning a hole in your checkbook. So, are there ways to improve efficiencies? Idex came out with a great report last year about the need to improve our efficiencies. AVMA has done some studies that indicate that the vast majority of veterinary practices are working at about 50 to 60% of the efficiencies that could be there. When you increase your efficiencies, you can generate higher productivity, be more effective, and be more profitable. And so there's a lot of moving parts that go into this conversation. You're very fortunate. You are probably focused on every molecule as it moves through your practice. As I said, you spend a lot of time both working in and working on, but if we're going to start to be able to address some of the challenges, can we do it with fewer people? Can we do it with lower inventory? Can we make sure that we are using our physical plants from an optimal standpoint? And can we do so and meet the needs of our

Host: clients who, I'm sure you have a very diverse clientele that range from those who can afford anything to those who barely can grow scraping by? Yeah, absolutely. We do. I would say our efficiencies are pretty good when you compare the industry average. I got a vet sitting in dentistry right now doing two dentils this morning. So that's great. Two dentils ready to go. We've got one vet standing in surgery. We've got one vet who's got three exam rooms filled right now. But there's still as a lot, you know, the industry still has a long ways to go. I still have a long ways to go in terms of those types of things. I have not explored having technologies do wellness appointments at a cheaper cost. They do wellness appointments, but it's the same cost. Because I think that they provide the same level of value as a veterinarian. I don't think there is a difference. I think a well-trained technologist and a wellness appointment is providing the same level of care,

Host: service value to that customer. So it costs $118 to get a wellness exam and one vaccine. I always include one vaccine in my wellness is that, you know, so, so I think I think we're fairly price. But when you look at this, so let's say I have good efficiencies and I'm going to to increase my fees. You know, I typically try to increase my fees four times a year. Sometimes it's a moving target in terms of like, what are sometimes we're just sitting around saying what's it going to be 2% 4% 5% there's not a lot of advanced math that goes into it sometimes, but we're looking at our ABVMA fee guides. We're looking at the local market place. We're doing all the things that any business owner would do when they're setting their price of anything, whether it's widgets or ice cream or tires, you do that. But like, or do you truly just look at all of your numbers and put in 20% profitability and set your fees based off of that?

Host: Because I don't know what my fees would look like if I did that. It would be, I think we need to start to retro and work from profitability back. So if you use the general benchmarking and you start with 20% profit and you've set your staff payroll at 20% and your doctor payroll at 20% and you're cost of goods at 20%. They're 60%. Well, that leaves you 20% for everything else. Can you do that? It's tight. It's very tight. So if you can generate more income through your technicians and your doctors without paying them more. In other words, they're charging more or seeing more. Because remember it's earns or turns, right? You can either earn more per visitor. You can see more people. Then you can increase your revenues. Keep those percentages maybe down below 20% and it gives you a little bit of wiggle room on that extra 20% that goes to everything else. So you play with those types of numbers and if you want to make your doctors, well, let me go back to your

Host: charging the same for doctor time and take time for wellness. If you're paying a doctor $200,000 a year, you're essentially paying them $100 an hour. If you're paying a technician $75,000 per year, you're essentially paying them $37.37 per hour. So your margin for a doctor at $118 for your visit and your margin for your technician or significantly different, aren't they? For the same amount of time. Absolutely. So either you're not charging enough for your doctor wellness visit or you're charging or you're charging appropriately for your tech visit. But if your doctors don't have to do that wellness visit, but they can do surgery, which is going to bill out at a higher rate, or they go in with a sick pet, which is going to bill out at a higher rate. Are you then getting a greater return on your technicians for the same fee as your doctors? Yes. So that's the sort of logic you can go through. If you want a doctor, it's going to cost you more, or bring it down for

Host: the technicians. But you're still, I think you may still be, I can't comment on the fees and we shouldn't probably be talking with real numbers because of federal trade, commission, discussions in the United States, at least. But I think you may be underutilizing your doctors in those situations and appropriately utilizing your technicians. Right. Yeah, that's just, I guess, one approach when you think about, okay, from first principles, if this is the profitability that I want to look at for this practice, completely throw out all the other things that, you know, the business person in me is looking at, you know, looking at the competition, looking at, you know, what price can we bear? During this inflation period last year, I lost sleep for weeks and weeks and weeks over this decision. We increased their prices 20%. And I was convinced, I was convinced we were going to lose 20% of our clients overnight. 20% increased, seemed insane. But like, I had to, I, the, the, the

Host: inflation was was, was preposterous, everything was going out, right? Nobody said a thing, not single client, nobody complained. That's, you know, we've talked about that. There's a lot of practices. I would say 30% of the practices increase their fees during the pandemic to act as a gatekeeper and slow things down, but it didn't slow things down. But it will, it may slow things down going forward and it may be what you're feeling right now is a retroactive response to that because I don't think in your situation, there's been a decrease in the value proposition that they're getting for that. But in many cases, there wasn't a value proposition to begin with. So they increased their fees, but didn't increase their value proposition. It's like, I'm still in a three, I'm still in a car with three wheels and you expect me to pay more for it. So I, I think your situation, you can work backwards for profitability because you've got a

Host: clientele that is, has bonded to your practice. Those clients who don't want to pay then that fees have chosen to go to a different practice. Those practice who don't know then that fees may be surprised on their first visit and it's how you treat them that will ultimately determine whether they come back. And so part of what you should be keeping an eye on is your lapsing clients. Client first visit equals last visit. The clients who haven't been in as a repeat visit over the past 12 to 18 months, not just the new clients because the new clients will be the podium and fan club, but it's the existing clients who taste tested you once and didn't like the restaurant. Yeah, we, you know, there's different stratifications in the industry too, right? So we, they're definitely is these value type back clinics that have relatively low wellness, you know, exam fees. Their Spain newter pricing is, is pretty competitive.

Host: We're higher than those, there's no question. But we're still probably 20 to 40% less than the corporate back groups in terms of our fees. For a lot of different reasons, I don't, I don't know if, if they've figured it out, if they've cracked the nut, to do one-on-one pricing, to the corporates, seems a little aggressive. Based off of what I could see, but on the flip side, what you just said, I, I provide that value, like I provide the value for that fee. That's a hard one, you know, hard pill to swallow. I deserved that fee, I'm just not charging it because I think sometimes they're, they're a little, um, elevated. Yeah, well, you, you have to get you and your team have to sleep at night. And so the conversation that we rarely have with our team is, what are you hearing on the phone? What's the, what are the clients saying at the front desk? And how do you, as a staff member, feel about our fees? Because they're the ones who are most

Host: tapped into the body language and the verbal language of clients when it comes down to the cost of care. Absolutely. When we, um, when we made our 20% increase, so almost all of my veterinarians do welcome work at other clinics, right? So they work four-tans. I have, you know, no restrictions on them going and working. I think it's been a great idea. They learn different skills. They network with different colleagues. Uh, they are able to, um, you know, augment their income to whatever capacity they want, right? They're, they're working four days a week and they make a good wage. And if they, you know, want to pay up their soon loan a little bit faster, they'll pick up that ER shift and on and on. So, but they were also very familiar with a wide swath of veterinary clinic fees across the city as well. Um, and they actually expressed frustration at how low our fees were because if they felt like it devalued them as veterinarians. Well, then you have some

Host: feedback from your doctors, but I would go to the staff because the staff, the ones who deal with the clients. Now, I worked for practice where they set up 10% of the clients aren't complaining about your fees. They're not high enough. Do you do, do you do client surveys, don't you? Um, selected ones, not broad ones. All right. So, maybe you want to do a little bit of a broad base, something at some point in time. And again, take a look at those clients who came in once and didn't come back again and it's been 12 to 18 months. Because if you don't have laps in clients, in other words, everybody keeps coming back, then your fees are probably perfect. If people aren't coming back because they moved, okay, no biggie. But if they're not coming back because your fees and you have a significant number of people who aren't coming back, maybe you've set up a gatekeeper. My gut feeling is you haven't set up a gatekeeper yet. In other words, you're 20% bump, got you to the right-hand

Host: side of the bell-shaped curve. But you're still not at the nose. You're not at the nose. You're you're far away from the tail, but you're not at the nose. Yeah, well, I would, I would definitely agree with you. I don't, like I said, I never get price-pushed back, still. Right. So let's, let's pivot. Gotta hate that word. Let's, let's, let's change it, but let's stay on the same concept, which is this, this fact that that where we're seeing cost of care escalating at rates higher, the national inflation, as I noted, and it's becoming more and more difficult to pay for care for the average, the center of the bell-shaped curve, pet owner. And, and you've heard the term spectrum of care access to care, and, and I look at spectrum of care as, you know, giving people choices with a similar standard of care, but giving people choices, and then you and I have, well, I'll give you credit. You came up with the concept of values-based care, and the new gold

Host: standard definition. So let's talk about a value proposition of care that is not based on on anything more than what the pet needs and what the client can afford. How do we start to move in that direction, recognizing all of the variables that go into the conversation, including state, or in your case, provincial regulatory boards, who kind of define that standard. So how do we provide the bronze and silver instead of just the gold, and still, you know, be affordable, take care of the pet, and you know where I'm going with this? Yeah, so I think it's important, of course, you and I know it, but just to define that gold standard, gold standard definition, right? So offering a customer, the best, in quotes, best potential option. So, for example, a dog comes in limping, you, you know, right, hind lameness, there's some swelling over the, the stifle, and you say, you know, I'm thinking this is potentially a cranio-cruciate ligament, tear,

Host: the gold standard option for you now client is for me to refer this dog to a board-certified orthopedic surgeon. Here, here you go. Here's your, here's your form. I've now referred that. That's, that's considered gold standard, and that's what a lot of clinics do. It's you can provide the best level of care than you refer out. That is the most expensive option as well for obvious reasons, right? That includes, you know, the best trained, the best diagnostics, on and on and on. But then it's very easy, I guess, for me and my practice, to say, okay, that's the gold standard option, and here's the next option, and then here's the next option, and here's the next option, and here's the next option, and I don't, I don't even know where you're at in terms of your ability to pursue that option or that. I'm just giving you all the options. I'm giving you all the levels. I'm not making any sort of preconceived notions. There is times

Host: where we've trained our client care team to, to talk to customers about what's your budget up front. Like, okay, your dogs gotta, are you coming in with inappropriate urination? Do you guys have a budget that I can tell the doctor about? And then we know what we're working with. And most of the time, it's, it's high. They're like, I don't know, a thousand bucks, and we're like, great. We're going to have your cat all fixed up for 300. So, so, offering that level, care just seems so natural, but it's, it's so very, and, and, and an, an integrated part of our practice, it's all we do all day long. We, we offer, best approach, and then the next, and the next, and the next, and we continue to educate and form the client until they can find a solution that works best for them. For the people that don't have anything, who, who walk in and tell us, I $50, please help me. We then just pull all the levers to be able to help them. Whether or not that's scratch pay or an

Host: internal financing, is it, you know, different grants, is it rescues? We work with customers all they long to give them an option. That's, you know, that's values-based versus gold standard. I, I don't know what, where we went, I think that's how they used to do it back at the, the dawn of the profession. We could do this or we could do this or we could do this, which one do you want? My opinion with the VMA is, as long as I'm recording that appropriately, that shouldn't be a problem. Gold standard was offered, and the next level was offered, and this is what the, the client could do. That's not me practicing bad medicine. I've just practiced the best possible medicine. Medicine isn't necessarily doing something physical to fix that animal. It's, it's providing, that's the art. It's providing a lot of different options, which is better than nothing, right? Because the alternative is gold standard or nothing.

Host: This is what we're seeing in my opinion, at times, I rates of youth in Asia at some of these gold standard clinics. It's, it's one way or nothing. Yeah, and I, having been there at the dawn of civilization, you know, if you've watched the beginning of 2001 at Space Odyssey, I was one of those monkeys. Maybe I was no, I don't recall. But there has been kind of a change. And when I was in practice, we tended to lean towards the gold level until we got some pushback. It sounds like you're not necessarily waiting for the pushback. You're giving them multiple menu items. Instead of having a price fixed menu, you've got a buffet. And so many practices don't have a buffet, or they only bring the buffet out when the client says, well, I don't want everything on the price fixed menu. And so I hate to keep going back to the restaurant industry, but it just seems to be a good analogy. So the interesting question that you ask, and it's, it's one that would have

Host: made me and made my staff very uncomfortable, is that budget question. So is that something that you got scripted with your people up front, or is it only used its specific times? Do you do it in the exam room? Is it on the welcome to the practice form? I'm just curious as to where you integrate that. So what's your budget for today, Mrs. Jones? Yeah, so it's in the sick appointments, right? A new patient new client where we just don't have a full understanding of their situation under their context. We felt the same way too. When we were first presented with the idea, we had done a group-wide communications course with a registered veterinary technologist who does nothing but teen communications, continuing education, and she had suggested it, and we had tried it, and we found that it was actually pretty rewarding. So you know, we're not asking it every time when it's a regular customer and we understand their specific situation and we have a relationship

Host: with them. But for somebody that's coming in, it can really help alleviate some of their fear and anxiety as well, knowing that they're not waiting for a bomb to drop. We're already having the conversation of like, okay, so, you know, Dr. is going to come in. Is there any budget concerns that we should go over? So we know what we're dealing with. We're here to help you. It's the context, right? It's like there's no judgment in it. It's, it's let us know now so we can get on the phone to the rescue. So we can get on the phone to, you know, to scratchbait to try to expedite this for you. So so you can pick the best possible option that you have. Don't have to egg and eyes about it after the fact. So it's interesting when we kind of talked about this offline. I think you called it values based care. And I probably interpreted that in a couple of different ways because values could be your core values and the care is based upon your core values. And you could

Host: read it as value based care, which means we're going to give you the best value for the care that you can afford. And so it sounds like you're kind of a hybrid of the two. Your core values are based upon the patient's needs, but concurrently you provide high value for those needs at the same time. So you've kind of got a combination of values based care and value based care. And then I'm not trying to split hairs or play on words, but it is an interesting discussion. So when you came up with this conceptually, were you basing it upon your core values or trying to put a value proposition in front of the clients? No, it organically came from the core values, not of myself, but the rest of the team, interestingly the founding team all but one came from a mixed animal rural background. And it's just what we've done in our whole lives. It was just second nature. This is just kind of that small town sort of approach to things. These are your neighbors.

Host: Right? When you're neighbors with every customer you have, you have a very different approach to how you do business. So same thing, right? It just naturally organically came together that we were going to provide based up of our own values, a value proposition for the customer. Under the umbrella that any care is better than no care. So the state boards in United States tend to make some decisions many of which are based upon communication more than malpractice. And so I have to assume that you have a team that has exquisite skills in communication, because it is very difficult to explain why you didn't offer options C first. And you went right to option A. And it's also very difficult for many people to ask about the budget side of things. So I want to just dive into a different discussion for just a minute, which is how much time do you spend creating scripts or talking about communication or role playing,

Host: or is it just the fact that you've got a whole bunch of Canadians working for you who are way nicer than Americans. So into American colleagues. No, you know, the only scripting that we've ever done is just for the first touch point with our client care coordinators. You know, the first time that a new patient new client comes into a room to hit on all of those touch points. Absolutely nothing with the medical team. That comes down to hiring, right, constant communication, one-on-ones, checking in. Like they're, we're talking about this stuff all the time, but there's nothing specific dedicated, right? It's hiring them right people, making sure they're in alignment with your mission, and your core values, your strategies. The people already knew how to do this. Do you, um, see, you've got the right, you have a process for hiring the right people. In other words,

Host: you have to have more than a pulse and can fog a mirror to be able to work for you. It's pretty competitive because you have people interested in working for you. Yes, so what would you say give us a message to other veterinarians so that that they could learn how to do a better job and be an employer of choice, instead of an employer of chance? Yeah, I don't know if people ever think about how big of a long game talent acquisition actually is. I've been, in effect, I've been trying to acquire my next veterinarian for essentially a decade in terms of my actions, right, in terms of my storytelling, in terms of the content that I put out there, in terms of the networks. The most recent veterinarian that I hired, she was a veterinary student of mine. Oh, God, seven years ago, right? She came to my practice because I, you know, I had a social media presence, um, social new about the practice. She came to my practice because one time,

Host: I struck up a conversation with her dad at a gas station, um, because that's just who I am, and his daughter was in bed school and, uh, you know, he was so excited for her to graduate. I hired her because I was her future father-in-law's veterinarian and it had always done a great job. Like, like, the reason that I got that next veterinarian was because of a whole bunch of different things that I actively work on all the time and have been for the last 10 years, because I knew that I'd have to hire veterinarians. I, you know, I, I took students in to, to do externships and did all the hard work of that of knowing that you're going to do hundreds and hundreds of externships, maybe to get, you know, five or six great veterinarians, um, over, you know, over the course of your career. But like, that's how this stuff works. There's no ad, there's no ad, copy, there's no silver bullet, there's no magic way. It is 10 years of grinding every day to

Host: network, to great relationships, to tell a story, to make your practice be known, that then, you know, looks like it's a success overnight. So you have trained for marathon. And you are pacing yourself, although maybe not right now from what you're saying, you're pacing yourself for a marathon. On the other hand, on the other hand, we have a plethora of veterinarians, plethora of colleagues, who, when surveyed, would not recommend veterinary medicine as a career, to their clients, to their family members, to their friends, to the person sitting next to them, on the airport, at the airplane. You, on the other hand, are totally committed to your future in the future of the profession. How do we, what, what's your take on this? What, how do we, how do we reprogram the, the profession in the future so that we are supporting and and growing each other and, and making this profession, how do we make more

Host: coatings? I don't know that, but I've always, I love thinking about this veterinarian's recommending to people to be veterinarians, right? And just as a, you know, just as a thought experiment, I've always found it, you don't realize it when you're in vet school and you graduate, but like how insane is it that us at 16 years old, 17 years old, three years old, 14 years old, decided we knew what career we wanted. And then we do this really hard thing that takes us eight years to do, and then we're in the profession and we, some of us realize we don't like this specific thing we thought that we would like to do, but we stay in it because we feel like we're too far in. We're too deep, we've invested too much money, too much time. You know, this is who we're in dentity is I sometimes I'm surprised it's not, it's not more like I'm surprised that we don't have people quitting veterinary medicine after two or three years in, you know, in, in drugs,

Host: it seems like that's what we would be expected. How would you know what this job is supposed to be, right? I had no idea. I just got lucky that I liked it. That's all that it was. So, so I don't know why that's shifted. I don't know why people are recommending it less and less. Doesn't matter, I don't know, but it's, I feel like on one hand, it should be okay to tell our colleagues, it's, you don't have to be a vet. That's okay. Go do something else. And I know that's hard. You got the, the debt load, what else is going to pay you the same on and on and on, but like the pressure that some of my colleagues are under to continue to be a veterinarian because that's what they are, is, is wild because there's no other career like that. There's nobody out there who's a tire salesman or decided at four years old, they're going to be a tire salesman. Most adults have a career path that's messy and all over the place and random

Host: chances and good opportunities and from career to career and industry to industry all over the place. Yeah, I mean, it, it, it, it becomes an identity for those of us who are passionate about it, it becomes an identity. It's kind of like when somebody says, you're, I'm a retired veterinarian. I'm never retired. I'm recalibrated. I may do different things and I may not be in an exam room or up to my elbow or up to my shoulder in a cow, but I'm still a veterinarian. And so it's an interesting, I think, more so than any profession, veterinarians take the profession as an identity. I've had a veterinarian tell me the only good thing about being a veterinarian is saying that you're a veterinarian. The only good thing about being a veterinarian is saying you're a veterinarian. Wow, we said the fact that you're helping patients and pets and everything else is not a good thing. Exactly. So it opens doors, so they're leveraging the title for whatever they want to,

Host: but they're really not passionate about what they're doing. How do we bring passion back? How do we bring fun back? How do we bring, how do we decrease some of the stress and we know that there are mental health issues? And there are studies that indicate and Merck's got a new study coming out this week that identify the issues and bring them to the fore. Do you think that we really know the, we know the outcome is burnout, substance abuse, et cetera, but do we really have a work? Have we really wrapped our arms around the cause for some of these issues? Do you have a clue? No, absolutely not. There is this LinkedIn article, I can't remember what it was, but the just of it was maybe we should be limiting the access to to to youth and Asia drugs, to veterinarians because it's been shown that the increased risk of suicide increases if they have access to barbituids, right? You know, in the comments that follow, including my own,

Host: where I think we maybe need to solve the root of the problem and not limit veterinarians access to barbituids, like there's, what's the root, but I don't know what the root is, right? It's it's got to be multifactorial, it's got to be, you know, to a part, you know, the leadership component of this, where the veterinary leaders, who was in control of the industry, what is ABA may doing, what are state legislators doing, how effective are they that missions back to vet school and on and on and on, right? There's no civil bullets, there's no obvious solution, there's a lot there, right? I don't know which one I would even, you know, which one I would even tackle the most powerful thing I can think of as what we're doing right now is just having conversations, right? Telling stories, nothing's more impactful than learning somebody's story and being inspired by it and changing your trajectory of your life, you know, even for me,

Host: to the number of times that I've had people reach out to me saying, like, thank you so much. I owe my career in veterinary medicine to you. You were my inspiration to become a veterinarian. How nice does that feel? Maybe not so nice when you think about it on the flip side like you just talked about, well, are one and two of those people going to hate me because they wouldn't recommend being a veterinarian to somebody else and they were inspired by me? I don't know, right? There's a lot there. I have no idea. So the reports indicate that money is a big variable and that money comes in multiple ways. One is student debt. One is salary. One is the discussion of cost of care with clients. There's a lot of variables that go into making the stress levels what they are. You mentioned also, and I would suggest that help reviews and the like don't help. But you mentioned veterinary school. Now, this individual

Host: who you recruited for 10 years, you must have seen something in them at that age that said, you're going to be a great veterinarian. Oh, for sure. Yeah, this specific veterinarian, you know, now she's five or six years out. She's a high producer. She's well-loved in her clinic on and on and on. I knew in her that she was just a great person. That's all that I've never looked for skill in a veterinary student. I've used it as a joke for years and years that like, I can train a monkey to be a cow vet. I'm looking for great human beings because I don't know how to train that, right? So 100%. I have multiple people in my clinics that were students of mine six years ago that I had identified as one day. I would love to be able to work with you in a veterinary hospital. Not because you're a great clinician. Not because you have this phenomenal skill set as a veterinary student that your classmates don't have because you're just a really good person. So let's take that

Host: and go a little bit deeper. You say you teach at the vet schools as do I. If you were putting together a profile of a veterinary student who the vet schools should accept, what would the profile of a veterinary student look like to you and how would you go about finding them? For sure. So I've thought about this way too much because I would love to be the Dumbledore of a private veterinary school one day. And I've of course thought how what my acceptance process look like and of course it makes it it's no different than how I hire for my teams. It's it's to me it's super simple if I could have a half hour conversation with a person just like I do when I bring somebody through, I give them a tour and a chat of our veterinary hospital and we just sit down and we talk about life just like this. I'm a pretty good read on people. I can tell you know when there's some potential there. I can tell where there's some passion.

Host: I can tell if they've got good values. Do I get it right every time know but do I think that I'm a pretty good judge of character for sure? And then so that's what I do with the veterinary students. I would love to just I would love to be the person who admits all that students into vet school for for the entire world. It would be it would be based on a conversation and then I would put them in a veterinary hospital and they'd have to do a day with my team and then my team would say thumbs up or thumbs down. Well let's put this in the hands of the you know their future colleagues, the veterinarians, technologists, TAs and client care coordinators that they're going to have to work with in the future. The subset of incredible human beings that you would get out of just running them through my team's working interview, the same way that we hire everybody else. I think we'd select for some pretty incredible people.

Host: And guess what? They would be diverse. We have we have an immensely diverse veterinary team. So so it's not you know with the self selection it's we have all kinds of different individuals a working interview combination with a conversation with a real human being as opposed to how can we you know an MMI you know standardized the exams, M cats on and on. That's if I if I hired my team based off of many multiple interviews and M cat scores or some sort of standardized test do you think I would have the culture that I have today? No and you wouldn't have as much hair. Yeah, it would be a disaster but that's that's the system that you know we expected to get the output of veterinarians on it. I was saying I get why it's maybe I don't get why. I guess I could get the argument says the why it is the way that it is, right? They're trying to standardize it, they're trying to scale it, right? But like sometimes we need to do really hard things and

Host: then not everything scales into these nice, nice, neat boxes. So you've never hired a Voldemort Pat. No, I'm not even saying that the team makes mistakes, I make mistakes. But I think our track record is a lot better than if we did it any other way. What's the likelihood your kids are going to become veterinarians? I don't know. Over this past Christmas break I brought two my kids to work on separate days. So I brought my 10 year old son two days and it was interesting watching him. You couldn't get that kid out of the front of house. So he was at the front desk. He was checking people in on his own accord. He was running to the back and communicating with the team when he checked somebody in. He could see that he loved running the till. He loved caching people. He loved talking to people. He loved that customer interaction. When we were driving home on the second night, he had said, yeah, I think I'll probably go to vet school. And I was like,

Host: okay, why do you want to go to vet school? He's like, so I can work at a vet clinic. And I was like, you want to be in the back doing surgeries? He's like, no, I don't want to be in the back doing surgeries. I want to be in front talking to the clients. I'm like, well, if you want to do that, then going to vet school is not the job for you. He, you know, the business acumen of this child is out of this world. It gives me shivers to think about him. He's 10. Yeah. So he sees he's a natural born salesman. He's got charisma. He's got, you know, a true business mind in mindset. My daughter, I took her and watching her. She loves spending time in the back. She was much more animal focused. She loved helping the, you know, helping the technologist and the TAs. She, you know, she loved spending time with the veterinarian. And she loved coming in the room with me. My son did not go into an exam room for medical appointment at all. But my daughter was

Host: was right there on my heels, wanting to experience that. So, so I think, um, I don't know veterinary medicine is in her future, but I think something in the medical field is. And then my daughter's, my daughter's probably going to end up in a prison in Thailand for drug trafficking or something like that. So. Okay. Well, you've got two that you better not screw up and one that you better fix. That one. That's the youngest. That's the baby. You can just let those ones do whatever they want, right? I always, I always joke. She's going to be the, the knee cap breakers. She'll be the, the mobster of the family business. So 15 years from now, I'm going to find your youngest daughter. And I'm going to play this for her. Okay. You will. Hopefully I'm still around to do. So, from that standpoint, let's kind of tie some loose ends together and go back to the current economics and look at 2024. If we continue with the cost of business being what it is, which is continuing

Host: to escalate even though inflation is slowed down a little bit. The cost of care kind of stays where it is in terms of fees. Profitability continues to waver because of the cost of care cost of fees. And the number of transactions continues to slip. The practices that were really running on high, running in the red, not economically, but running in the red, I said, if they're engine, we're overflowing, they're going as fast as they can in the hamster wheel. Might face some economic challenges. Now, you're hinting that even your practice has been impacted by the current world. What in your crystal ball do you see, and I know you're not an economist. I'm not an economist, but what do you see between now and the end of 2024 down the road for the veterinary profession? Do you have any vision of where it's headed that you want to share? Yeah. One indicator that just peaked my interest this week as well, just to, I don't know if it's a North America phenomenon or not,

Host: but I, somebody had noted that there was 20 denobos being built in my city in this calendar year coming up, and we have, you know, approximately 1.3 million people, let's say. So that's, that's a lot of hospitals. That's a lot of new hospitals. And these are, these are all denobos, which is a wild to think about. Could you imagine an a million person's city? They're being 20 veterinary denobos? Of course, we all understand that once you put the plan in motion, it's really hard to stop whether denobos, right? So all of these were, you know, kind of put into to motion last summer, let's say, before any of this was really top of mind before appointment books started slowing down on and on. I'm not sure if that's being replicated in other places right now. Are we seeing this, you know, there's massive rise of denobos? Because if we are, that it's definitely something we need to think about, because those denobos are going to

Host: have to get staffed, and what are they going to get staffed out of? Those are existing hospitals, and what existing hospitals are there? You know, these are the one and two doctor practices, and these are the corporates. These are, you know, the majority of what we have. So what I think is going to happen is I think we're going to see some veterinary groups consolidate practices. I think we're going to see some practices close that have been under performers. I think we're going to see layoffs. I think we're going to see more layoffs of veterinary technologists and veterinarians. I think we're going to see practices close and also I'm predicting for this year either a veterinary group bankruptcy or massive cell off. I just don't see how it's not possible with the amount of leverage debt. Some of these groups got themselves into. I think we're going to see kind of some of the real world right now.

Host: Do I think, you know, to go all the way to the top level? Do I think we're going to see NVA IPO this year? It's possible. It's an interesting time to do it for all the reasons above mentioned, but, you know, to go right through all the way to, are we going to see some IPOs in the veterinary space? Maybe, but I wouldn't be shocked if we're going to see a 100 or 300 clinic practice group cell off its assets. I'm going to leave that alone because you and I both have a friend who is part of the 300 practice asset group and we'll just leave that baby alone. Except to say my summary of that is be uncomfortable because that's what we are. It's a very uncertain time. I do think that we're an inflection point right now of where this profession is going to head over the next 18 months to two years and I think it's up to the independent hospitals. I think it's up to the veterinarians, either independent or corporate, to control their own destiny.

Host: And I truly encourage everybody to pay attention to what's going on around them and to share their voice so that they are a victor and not a victim. Because I do think that we need to have a collective voice as veterinarians in your local state, national associations about controlling our own future. And, and whether you do that by doing a denobo or buying an existing practice, we're having a voice on some of the legislative and regulatory side of things. I think being quiet is not what we need right now from that standpoint. And that's how I love it that let's reflect how hard that is though Peter, right? Like we're putting ourselves out publicly with conversations and at least this amount of comfortable moments makes you second guess and question having a voice sometimes, right? No, I think as long as you note that it is your thoughts or your opinion, I think and and I do another podcast as you may know entitled courageous conversations and I think

Host: that's what we need to have. I think I need to get a new voice. But I do think these conversations at the grassroots level, whether it's two, five, ten, twenty, let's people know that we're all in this together. I think in many cases and and we're a fully aware of the introvert personality of many veterinarians, we isolate ourselves. We silo ourselves and I really do think that allows or doesn't keep us looped into all of the challenges that are out there. I encourage anybody and everybody to find a friend, find a colleague, and just have start having a conversation because I think a lot of the problems that we create, we create for ourselves by not knowing what's going on and not being tuned in and we become, it's like the phone calls that you get that said, well, when did that lot change? Five years ago, you know, got to be looped in. You got to keep your ear to the ground and know what's going on and we need to do this and so I invite everybody

Host: to call Cody and have a conversation with him and talk about all these fun things. Cody, any final words of wisdom, we're going to do this again sometime and we'll probably bring some other people in who might disagree with some of our different opinions, but any final words of wisdom that you would like to share as we look forward to 2024? No, I feel, I feel exactly on par with that that there's so much opportunity for grassroots movement for us to have conversations, for us to network, collaborate, to be, you know, the creators of our own destiny, endless, endless opportunity, there's a lot of battles to be had, but like I'll gladly go to battle with with so many of my colleagues and I'll be there shoulder to shoulder with you to try to address some of these things. Dr. Dumbledore, it's been a pleasure. Thank you so much Cody for joining us again and talking to us about

Host: well 2024 and where we're headed and where we where we can be and staying in control of our own destiny. I appreciate your insights very much. I always have fun talking to you and I want to thank our listeners. We appreciate each and every one of you and we can't do this without you. We would love to get some of your feedback as well. If you like our podcast, share it with your colleagues, friends, on social media, don't forget to leave a review on your favorite podcast platform because your reviews help me and others with some ideas. They also help other doctors and practice owners to find us. Until next time, keep striving for excellence and making a positive impact. Let's make this a positive year in the lives, your patience, your pet parents, your colleagues and the profession and I wish you all an amazing year ahead. Thank you.