The Future of Independent Veterinary Practices: Episode 4, With Debbie Boone

Well, I think I'm fortunate that I spend an inordinate amount of time studying people. And not to mention the fact that I'm old. I've been around a long time. Experience is a really good teacher, and when we started the, I guess, the lockdown, I did a little video for people and I said, "Look, it'll be all right." Because I was a child in 1968 when we had a pandemic, and a million people died. But people forget about that, or they haven't lived through it. I was a child when there was racial unrest, and I can remember the National Guard and us having a nine o'clock curfew. You'd had to come in from play in the yard, and as a tween, I guess is what you would call it now. And looking back through multiple economic crises, the dot-com bust, I mean, I've managed practices through four economic downturns.

So, the message that I sent out to the universe was, "It'll be okay." And I think we just need to live in the present. One of the big mistakes that people make is worrying about the future and fretting about the past. I mean, there's not a damn thing you can do to change the past, is gone. And truthfully, you can't do a whole lot about the future except the best that you can, because that's tomorrow, and you don't know what's going to come. But today, today, you can live in it. Today, you can enjoy it. So, I like to dig around in the yard, I like to step outside and watch the eagle that's come in and out on the marsh. Because I realized that if you're constantly worrying about something, if you're constantly inputting just garbage into your mind, then you're never going to be able to be happy. And it is a choice.

I study neuroscience a lot, and it is truly garbage in, garbage out. Because if we spend all our time on social media, listening to the news, listening to negativity, our brain doesn't know the truth from a lie. It only knows what we feed it. And we've got to feed it the right thing. So, feed it good stuff. Just as you would feed your body a healthy diet, feed your brain a healthy diet of positive affirmations, of gratitude, of looking past, the news line, the breaking news, which is a total crock. When I was young, Walter Cronkite was a reporter. And when we had breaking news, it meant, the president got out of assassination, or we landed on the moon. That's breaking news. The rest of this stuff is just news.

It's just not even really news, it's just a bunch of garbage. But we've become very sensationalized in our society, and I think we need to push back and mentally say, "I'm not buying into this. You're not going to play me." Because I think it's a game that we're being played. And when people wise up and realize that they're being played by algorithms, which can be helpful, I'm not going to say they're not helpful, but they can be incredibly detrimental, is just to step back from all that and don't believe it. Just do your own research, read your stuff, step outside. Less screen time, more nature.

We do need to know how to play the game. I call it taming the dragon. On my Facebook feed, I gave this tip out at the beginning of the election cycle, anytime anything political came over on my Facebook feed, whether I agreed with it or not, I would flag it as spam or in fake news, and I would report it. Now, was it true? I didn't care. I just didn't want to be bombarded with that, and it was training the algorithm to say, "She doesn't like it. Don't feed it to her." Now, this is on both sides of the ally. It didn't matter. And I want to tell you that during this past election cycle, I had absolutely nothing in my Facebook feed that had to do with the election. And it was a very pleasant experience to scroll through, look at all my managers' groups, help them with COVID problems, and not have to worry about the absolute nonsense that was coming over from some of these fake news sites.

And people don't understand that once they click on one of these items and read it, whether it is from a legitimate news site or not, then the algorithm says, "Oh, they liked that. Well, let me give them more of that." And it becomes more and more and more extreme. And as human beings, we are tribal. So, we evolve to work in groups. This is why any management consultant, including myself, is going to tell you to have a mission statement for your hospital to determine your core values and determine your purpose, because your team needs to agree with those core values, believe in your core values, and agree in your purpose, and then they are all motivated to move in the same direction.

You begin to believe that everybody thinks like you, or like whatever this algorithm is feeding you, so, you are misinformed about 75% of the other people that are out there in the world, because you think everybody thinks this way. And this really probably would not have happened, unless COVID. It was kind of this perfect storm that happened because COVID also limited us and our freedom. And when we get out into the world and we're having conversations with lots of other humans, those conversations keep us rational, because they keep us in check. If you go off the rails and go off on some tangent, somebody else is going to say, "That doesn't make any sense. Why would you even think that? That's ridiculous."

And it pulls you back. But there's nobody there to say that because you're sitting alone staring at your screen and getting fed more and more and more of the kind of crazy stuff that's... or more and more extreme stuff that's coming along, and your brain doesn't know. And they make it sensational so that we get this little endorphin boost, right?

What I'd love to do is pivot a little bit, let's take a bend in our journey here and talk a little bit more about trends in the industry, trends in the veterinary industry, and in particular, one that we kind of, in our conversations leading up to this, we settled in to talk about, is this trend of consolidation. Being that we're both very aligned with the good of independent veterinary practices at heart, and who we seek to serve and help protect and uplift, this trend of consolidation is disturbing for the future of independent veterinary practices. Why do you think, why are practice owners selling to these corporate consolidators in the first place?

You have to figure that most of the practice owners who are selling to consolidators are at retirement age, and they've worked all their lives to build this practice up. And as much as they would like to sell their practice to an associate, often, we went through kind of a period where the associates weren't really engaged in buying practices because they saw these baby boomer practice owners spending 70-hour workweeks, all hours of the day and night, never having any time off, seeming so overburdened, and they looked at that model and they went, "Good God, I never want to do that. There's no benefit in that whatsoever."

So, there seemed to be a lack of incentive in the associate pool, to want to step in and buy those practices. So, that was the number one sort of aspect there. But then, consolidation started to happen. Well, the consolidators, I guess these things started maybe 10 years ago just to be on our radar, and we always had the big ones like Banfield and NVA and VCA, and they were buying practices, but it was just those three, and maybe you had a little independent group here and there. And then all of a sudden, money got cheap and investors were looking for sure things, and veterinary medicine is always a sure thing.

You and I both know that rarely do veterinary hospitals default on anything. They always pay their bills, and they always stay in business. And the major problems that they have usually come from the back end, where they're not really managing the finances tightly, or they have HR problems that they don't manage well. So, the consolidators basically saw an opportunity here as an investment, to say, "Let's get into this space, let's clean up some of the business parts of it, because the medicine we don't know anything about, we don't even care." This is an engine, it's a tool for them. They don't care about the animals. They don't care about the medicine. "We just want the tool." And so, they threw money at it, and they threw a lot of money at it. In fact, I have many friends as VetPartners member and someone who sits on that board, who are evaluators. VetPartners, as a matter of fact, holds the Veterinary Practice Evaluation Council, and they are the ones who write the rules of valuing practices, and that member circle. So, these are the people who say, "This is how you go in and figure out how much practice is worth." So, all of a sudden, these practices, who would have sold for X number of dollars, are now selling for 5X number of dollars, 10X number of dollars, especially if they're attractive.

And they're attractive to some of the corporates because if they are in a location that is near multiple other corporately-owned practices, then there's the efficiency of scale. They can put one regional manager in there to look after non-practices, as well as they were looking after seven, and they can ship products in there, they can have meetings with those groups. There is an efficiency of scale. So, they like to have groups of practices. And many practice owners, my first practice owner owned four hospitals. He did, however, sell each one of those practices off to the lead associate. And he gave the real estate and he's a landlord now. But a lot of practices don't... they don't run that well compared to this, and so, here's this windfall of money that they could have, and this is their retirement.

So, it's almost impossible to turn it down because there's so much money being thrown at you. And I know I've had conversations with several practitioners who've sold to corporate. Now, that's not to say they're not happy, because a lot of the practitioners who sold, stay and work in the practices, and usually, the agreement is two years, but they like it. A lot of the burden is off of them, there's freedom. They love the medicine, they still get to practice, but they don't have to manage the back end. Butregion, that group, that locale? And can you work within the parameters of a corporate group? And each corporate group seems to have a little different emo about how they go into practice. Some of them don't touch anything, they just give you some leadership on the HR. Some of them come in and change everything, including your software. So, investigation, I think, is key, if you are thinking about selling to a corporate group. You better find out who you can live with for a couple of years at least. And if you want to protect your team, that's the other thing too.

There are viable alternative exit strategies that are really interesting. Dr. John Tate really speaks on this a lot, and it's fascinating and something that I think any veterinary practice owner who's considering selling should really be looking into alternative exit strategies.

There's a very interesting new thing, I guess, that has come onto the market for me, and that is, there are groups now that are buying veterinary buildings and not the practices. So, they actually become the landlord. And if the veterinarian is looking to take equity out of the practice that he's built, but he doesn't want to stop working, then there's the possibility of just saying, "Well, let me just sell to one of these guys, they'll be my landlord, and then I will continue on my merry way with my money in my pocket and my veterinary hospital." And normally as a consultant, I wouldn't say that that's a great idea because I do think that if you retire and you're a landlord, you're a landowner, then you do have residual income coming in as the landowner.

However, if you know that you have a building that you're going to have to spend $45,000 on putting a new roof on, and you're 70 years old, then maybe being a landowner is not a great thing, and you might want to say, "You know what? Let me put that burden on somebody who wants to keep this building 30years because I don't," and there's an option there. So, you're right, there's creativity there, and you're right, some of the consolidators just want partnerships. They're not looking to buy the whole hospital out, they just want to partner with the practice owner.

And then there's even a conversation that Charlotte Laquan has had many times in Charlotte's and Advocate for, is a windfall for associates? Because you have associates who've worked in these practices for 10, 15 years, they are not practice owners, somebody comes in, buys the practice out, the practice owner gets an incredible windfall at 10 times EBITDA for these things, and then the associate's left working for somebody that they don't want to work for. And so, there's a formula that says, okay, depending on how long you've worked, what your production is, how long the business has been in existence, then you get part of that windfall. And I think that's another thing.

And then that associate, if they want to go out and start a practice, has the nut, right? They have something that they can take, and/or they can pay off student loan debt, or they can go and find a bargain hospital. Because you know and I both know that most consolidators are not interested in a little one-doctor practice, they want at least...

Scoop up the crown jewel practices, at least have a good section though that then they can point if they are getting the underperforming practices. "Hey, this is, let's learn from our ones that are doing it well."

Exactly. So, there's a lot of small rural practices that are not attractive to consolidators but could absolutely be, they're almost like a bargain basement that an associate could buy and transform. And I've seen this happen several times in my career, where somebody... Actually, there was a story of two practice owners, they had bought their practice about a year and a half prior to that, they came to my Patterson communication class, shut the building down, brought their entire staff. This was their commitment to communication and customer service. So, they brought the entire team to a class, and they had bought this practice that was a horrible practice.

It was in the middle of a terrible place in L.A., the practice owner practiced horrible medicine. The people who work there were a nightmare, for the most part, they were very negative and poor customer service. And so, these guys had been doing a little relief work. They came into that practice, they got rid of some of the toxic employees. They had core values of service to the community, and they started doing specialty dental work, because they were capable of doing those things, and they transformed that horrible-producing, low bargain-basement practice into a great practice that was profitable within its first year after they bought it.

So, these transformations absolutely can happen when some of these older practices have been run into the ground, but there's a need in that community for an associate veterinarian who's interested in really serving people well, to get into there, clean the medicine up, clean the customer service up, offer the community great service. You and I have had this conversation about independence, that's the agility and the bonus of being an independent practice is, you are agile. You don't have to ask anybody for anything. You can fund the latest technology, you can bring services in. Nobody has to give you approval for that.

You can hire and fire people that are not playing by the rules in your hospital, and you can really transform a low-performing practice in a year's period of time.

We've helped veterinarians do it from just a marketing perspective, but not just marketing because marketing is so much more, it's entirely identifying who you are, looking back at your mission, values, and culture, and ensuring that every aspect of your practice really is staying true to that and is really well aligned with that, and you're expressing it well, and you're educating people, and you're living out exactly what you aspire to. And that you're demonstrating it.

And you stick to the brand because that's the other thing, I think, that veterinarians struggle with, especially the independents, is they try to be all things to all people. And you know you can't do that and do any of it well, you just end up muddying your pole. So, you've got to know who you want walking in your door, you've got to market to those people, and you've got to serve them the way they want to be served. And those are messages that most... Veterinarians don't learn that stuff in school. And you want to make sure that you're staying true to yourself and true to your brand. And if you have a customer who comes to you who's not your ideal customer, and they are difficult and they fuss at your staff, then it's okay to release those people back to the wild, right?

You don't have to serve everyone, let people who are treating you or your staff poorly, and they're just not good clients, let them go.

Let it go. That's right, let it go. You do not have to deal with them. Well, it always has been incongruous to me that we will have great clients who never fuss about anything, and we're so happy to see them walk in the door, and we charge them full bore for everything that we do. And then we have these people who are a total pain in the neck. They gripe about every dime that they spend with us. We have to just battle with them to get the least amount of care done for their pet, and then we give them a discount. That makes no sense. What we've done is reward bad behavior. You know what? If you're a pain in my butt, I'm going to charge you more, and not less. Not less. The good people deserve the deal, right?

This is one thing that my partner, Dr. Michele Drake, and her practice, never offer discounts. There's no way. Discounts are just not a part of the culture of their practices and what they do. If a bad client shows up, they'll let that bad client go and not have them back. I mean, really, really protect, and they are definitely not hunting for business, they're not hunting for veterinarians, for staff, high-quality five-star doctors and vet techs and all the staff they could ever need, and there's just a constant stream of applications because... And they're actually happy in there. They're friends with each other. It's a non-dysfunctional workplace.

Exactly. The goal is to be the place where everybody wants to go, and the place where everybody wants to work, and the place that everybody wants to buy. So, those are your three goals as a veterinary hospital.

Next week, we're going to have Daniel Eisenstadt on the program, and he's the CEO of Terravet Real Estate Solutions. Just had a fascinating conversation with him a couple of days ago, about what we're going to be chatting about. We're going to be talking about a lot of these same topics but from his perspective. So, fascinating ideas from that man. But it's an angle that was a little bit newer to me in that, I must admit, in the conversation with him, and I'm not as surprised at all to just hear that you're well versed in it and, I mean, talking about it.

I try to look after my clients and bring them anything that I think will help them. I think that's the advantage of being a consultant is that you're not in practice every day, just in the weeds, that you have the time to explore and find out what tools are available for people, and bring those to the table. I had a conversation with a new client yesterday, and he said, "I really appreciate that you have all these things that they're just not your things." No, I can't possibly build all the things that you need, but I know stuff, and I know people, and I am more than willing to reach out to my network and say, "Go help this person because they're an independent guy and they need some help and you are the person in for them." So, take advantage of your network, and that's my belief, and build a network.

Let's flip that coin and talk about the other side. What would cause more practice owners to want to maintain ownership, do you think?

Well, as a practice manager for 23 years, what I guess my perspective is, tell those practice owners to go practice medicine and drive revenue and let me take care of the rest of it.

There's a fine line between delegation and abdication. And it goes both ways. And so, I've seen veterinarians who hire a practice manager who has skills and knowledge and micromanage them to death, to where they can't get anything done. Or, they're so glad to get rid of these duties, that they never check back behind the manager, they're just like, "Oh, here you do it," and they walk away. Well, the middle road is where we need to be because it's like Ronald Reagan says it's trust but verify because if you have a practice manager, they do have a lot of power in your hospital. They control the accounts, they know your passwords, they have your credit cards. You need to be putting systems of checks and balances in place to make sure that you don't get embezzled from.

And you don't like to think that, oh, somebody you know and trust would steal from you, but I will tell you, it's happened to me in my practices, and it was just kind of a perfect storm of our accountant quit, and the bookkeeper quit, and then we got this new manager, and we had a new lead veterinary associate in this hospital who didn't want to confess that her manager wasn't behaving well. So, it didn't happen very long, and we caught it fairly quickly. But I had a good friend who owned a practice and had a girl work for him for more than 20 years, who he never discovered had stolen over $300,000 from him, until the IRS got ready to close the doors because she did not pay the payroll taxes. And believe me, they frowned on that.

Going back to the trust but verify, putting systems in place, when you try to do everything, and this is for the managers too, here's a lesson for the managers too, when you try to do everything, you do nothing well. You need to do what only you can do. I have a whole talk on delegation and it talks about the buckets. So, you have three buckets. The buckets are the things that you could immediately delegate right now, make a list of the stuff that you can give away. I gave a talk for AAHA, and I have this full room of managers, people standing in the back, and I said, "How many of you are opening the mail in your hospital?"

And all these little guilty hands started to rise. I went, "You mean to tell me you don't have a $10 an hour part-time receptionist that can open the mail and throw away the junk and put other things on your desk for you? How many of you are taking the deposit to the bank? Why? That's at least 30 minutes of wasted when somebody cheap can do it." So, you delegate a duty to the lowest paid person who can do it well, and who has an interest in doing it, and then you check behind them. So, that's your first list, the, "Let me get rid of it right now." The second list is, "What can I delegate to other people with a limited amount of training, that it wouldn't take them long to get trained up to do this stuff?

And these are things like inventory counts and putting data entry into the computer. So, we pass those things off. And then the last list is the things that only you can do. These are confidential, these are strategic planning, these are building your marketing plan. Not doing your marketing, but hiring the right people to strategically get your marketing plan out there to the world. And then, after a couple of months of this, I want you to go back and you look at bucket number three, and you look at that bucket and you go, "Okay, now how many of those things can I really get rid of, now that I've thought about it?"

And so, my practice owner, the first practice owner, the last year that he worked, only worked one week of the month, and then the last six months that he worked before he retired, he didn't work, but one weekend out of the month, and he lived in another state and established residency there because they didn't have a state income tax, and he was selling the practice, and therefore, he saved himself a lot of money over the State of North Carolina, where we're from. So, having a good manager in place, who can delegate appropriately, and having good systems in place, gives you a great deal of freedom as the practice owner, to drive the revenue, to have the freedom to go on vacation, to not be on call 24/7 because your practice has been on kindergarten rules.

"I can't make a decision by myself, therefore, I have to go ask my practice owner everything." A lot of times, I will talk to practice manager groups, and when I tell them that I set my schedule for my staff three months in advance. And if they needed to change or have a day off, they didn't have to ask me, they independently changed days with other people. And I said I had two simple rules, "You have equal skillsets, and neither of you gets overtime. You don't have to ask me, you don't have to run it by me. I don't even care. I don't want to know. You're grown people, act like it."

And people are stunned that I would do that. And I went, "Why do I need to babysit these people? They're at least one of years old, and some of them 50." So, if you treat people like adults, they will come through for you. And if they don't act like adults, then you need new people.

There's a space in between delegating and abdication. When you're living in that world, in order to really reside there, I think what you need to reside there as a business owner, to manage your business, what are the things, the pillars you're going to set up that allow you to check the temperature of what's going on? Managing by metrics, right? Establishing those processes for checking in on people, so that those essentially can be fairly self-assembly as well, and you just get to come in and look at those, and you can clearly see the trends based on what you're looking at to know whether it's meeting your goals and it's working like a smooth-running machine, or it's throwing a red light and need some service. What type of thing would you advise on that?

I love a good report. I really love to root around in data. And you would think from my extroverted nature that that would be the last thing, but it's about a third of my personality style is to just dig into stuff and tell me the story of it. So, looking at the typical data I used to look for in my hospital, they're fairly common things, the average client transaction, the average doctor transaction, but I would take that even deeper and look at productivity reports for my veterinarians. And the last practice I had had 11 doctors in it. So, those data points that we looked at were, how many exams they were doing in the vaccines, because that tells you the compliance, but also, I wanted to see diagnostics on their service list.

re you doing good medicine? Are you taking the time to educate a client? Are you doing dental cleanings? Because we know that animals need their teeth cleaned, I think, every year, just like humans do every six months. So, who's producing? Who's doing those things? And who's falling behind? Because the norms are the norms of the hospital. And so, I had large animal and small animal veterinarians, and an emergency veterinarian. So, we were looking at those things compared to each other. And it will tell you who is good at communication, and who is, we at least say selling your services, but who is communicating the value of those services sufficiently, so that your hospital is making a profit from those things, but also your patients are getting the care that they need? And that, for me, that's where it all comes back to.

If I see one of my doctors, who's lagging behind my other ones, then I think they need education. I need to find out what the hole is in their process. And if they're introverted, if they're not comfortable talking to people and educating clients, fine, let me partner them with a technician who is a superstar at it. And we balance the teams that way, we hire to our deficiencies. And that way, we can add strength to that doctor and then we watch those numbers go up. Obviously, we're looking at our P&Ls. I mean, I have been in hospitals as a consultant, where they have not looked at their P&L until it's tax time.

And a tax P&L and a P&L that you're looking at to run a business, it's two different things. Because to an accountant, an expense is an expense, but to me, I want to know your drug cost, your labor cost, what your utilities are costing. I want to break those things down. How much food are you selling? If you look at something as simple as your pet food sales, and you know from your markup, the pivot company gives you your markup, what you're supposed to be profiting on that food, and then you compare your PMs to your QuickBooks, and there's a gap there, then who's walking out the door with your food? Right? So, your P&L to me, what I like to give the equivalency of is you have a diabetic cat, and you need to do glucose curves on this cat to regulate their insulin level. So, you periodically bring them in and you do a glucose curve, and then you periodically check where they are. If you don't do that, your cat's dead. It's too late. It's too late to get it back. So, we need to constantly look at those things and run those numbers, and have just a basic understanding. I mean, you don't have to be an accountant to do this, but just a basic understanding of where your money goes and what to look for in those norms. And then we have tons of benchmarks out there in the world, and some of the benchmarks, I actually consider to be a little low.

Profitability in our hospitals rarely is over 10 to 12%, and most businesses will be very happy with that. But 18% is certainly possible, but not at the expense of having your labor cost be so cheap that your people can't make a living wage and they can't pay their rent.

This is one area Dr. Drake, most dry, most veterinary practices are running on like a 10 to 12% EBITDA. The Drake Center has been for the past 25 years running at like 29%. And it's a high-functioning practice across the board. Everybody's happy, they're compensated, it's wonderful. So, it is very, very possible.

It is possible. And the other thing is when you don't have employee turnover, you become very, very efficient. And in my practice, I honestly had a comparatively low labor cost, but it wasn't because my people weren't compensated, it was because they were really good at their jobs, and they didn't make mistakes, and they were very committed to what I call the gospel of the hospital, which is what we believe. These were our standards of care, these were the products we believed in. This is why we believe those products were important to our patients. And every single soul in that practice preached the gospel, and the clients believed. They were believers. And because of that, they said yes to things. And it wasn't a battle to say yes to things, it was, "Of course, I'll say yes to things. You told me that was what my pet needs, and I'll do that." And when that happens, you can look after your people better, and you can have a highly profitable business, and you can have an extremely satisfied client base who doesn't fuss at you. I have to tell you, when I got out into the world of consulting, you have the impression, when you run a hospital like I ran a hospital, that everybody did the same thing. Maybe they didn't do it quite as well medically as we did because we were an AAHA-accredited hospital for 25 years.

But you thought, "Well, everybody believes along these lines." And I get out there and go, "Whoa, this is the Wild West out here. Some of these practices are not at all like what we managed our practice like." And you realize why there's such a struggle out there in the community. I'm so grateful for what the VHMA did for practice managers. The CVPM certification certainly is now something that I probably get a call once a month from somebody going, "Hey, Deb, I need a CVPM, do you know anybody looking in my state?" Well, there are still very few of us, there are still probably 500 to 600 of us in the entire universe. So, there are not that many out there, many of them are consultants or high-ranking practice managers in big hospitals.

But we could grow some of those people. If we encourage them, and we can grow them. And then Penn Foster has now a practice management program in their group, and then the St. Pete has had one for quite a while. So, there are programs out there to train managers on how to be good managers. The problem with a lot of managers is they didn't get taught. I was fortunate, I think, I grew up in business. My parents had a bookkeeper who was just incredible. And by the time I was 15, I was running P&Ls and payroll with Edith. Now, most 15-year-olds are not there. And I was understanding business because I grew up in it.

But most managers were just great techs, or they were great receptionists, and then they said, "Oh, you're doing good at this, let me go give you this job." I'm not going to teach you how to do it, I'm not going to give you any resources to learn, and I'm going to fuss at you when you don't do it right. And there's where we are.

I very much believe in promoting from within. You have someone who's doing a great job, you want to give them an additional opportunity. You might look at someone who you're like, "Well, the thing that you're doing is, that's where you started, but I want you to be able to grow on your career path and put you to this." But taking someone from a vet tech and turning them into... who's doing a great vet tech and making them an office manager, it's an entirely different skillset, it's an entirely different set of problems they're dealing with.

tend to look for, who did the team migrate to? And there's usually one or two people on the team that people always go to to get coaching or training or problem solved for them. Well, that's kind of almost a natural person, to say, "Would you be interested in this leadership?" Because, for some reason, they put off that vibe that people are attracted to. And they may not be your longest-term tech, they may not be even your most skilled tech or receptionist, but they're the ones that people trust. And trust is huge in having a manager that people feel like they can go to and help get through their problems, or help them with whatever's going on in their business and in their lives.

I've laughingly done many talks in my career and talked about having the box of Kleenex in the therapy chair in my office, and I've had conversations with staff about everything from impotence to abortion. And some staff, it was like, "Oh, God, I don't even want to know this," but you have to say, "I'm so happy that my staff felt comfortable enough to come to me with those things and get my help and perspective," or any tool that I had to help solve those problems for them. And certainly, these things were certainly sometimes above my pay grade, but I knew and I had worked to find resources for them to move them on from me to whoever really was going to help them.

So, let's look for those natural leaders in our hospital, but then get them some tools, give them continuing education money, send them to conferences, get them magazines, get them membership of VHMA. Do all these things, rather than leave them high and dry and expect them to just figure it out. Because it's a lot. It is a lot.

I really believe in that personal and professional development. And that when people are dedicating their lives, such a large percentage of the time of their lives to this business they're working at, to support their life, their family, and all of this, that using that as a vehicle for the personal and professional development, that leads to more fulfillment for them as a person, makes them more valuable, and absolutely, it's going to end up being better for the business overall.

And you remember one of the things that I said when I talked about delegation is to pass people off these tasks that you don't need to be doing, but that they're interested in doing. Because they have to be interested in doing it in order to do it well. "Can you do stuff? Yeah, you can do stuff." To me, I don't mind doing financial stuff, but there are people who thrive on that. There are people who avoid HR stuff like the plague, that's my thing. So, we need to figure out strengths and weaknesses, interest and avoidance, and put people where they will thrive. There's a book I really like that's called Shine, and it's talking about finding people, and very much like Good to Great, putting people in the right seat on the bus, and then giving them tools to shine in that position when they are given these responsibilities.

Even just some of the saddest things I see out there in the world going into practices, is they will hire a receptionist who is, you can tell this is an introverted person, and put them on the front desk. This poor girl, you know is miserable all day, and goes home and just probably crashes and hides in a room somewhere, because it's not...even if they're trained to do the interaction like they're supposed to, and say the things they're supposed to say, it never is fulfilling to them. It doesn't energize them, it depletes them. And there's a lot of that with veterinarians, there's a lot of introverted veterinarians, and they do good customer service, they're good communicators, but they're exhausted at the end of the day. And I think that's an important thing to note too, if you need a little downtime, a little Nirvana in the middle of your day because you're an introvert, then make that happen. There's a reason we have a schedule. Really, it is to control the runaway horse. And people do not use their schedule appropriately or they completely ignore the schedule. They put it up there, and then they completely override it, ignore it, and triple book themselves.

And if you are a veterinarian and you are doing this to yourself, we're talking about burnout, we set ourselves on fire. We do that. So, you're burning yourself up, and it's your choice. And people think, "Oh, I don't have a choice." Yeah, you do. No is a choice. No is a word.

And there's also this industry-wide call for there are not enough vet techs, but we actually have vet techs leaving the industry because they went and they got qualified, and they showed up just going like, "I'm excited for what I'm going to do," and then they're treated like a glorified reception staff and not allowed to do the things that they thought they were going to do, and they're like, "It wasn't fulfilling, I'm out of here."

Yeah, they become a dog holder. I've had veterinarians go, "Well, I think I need another veterinarian." And I said, "Nah, you really need a couple of techs, because what you're doing is expressing anal glands, cleaning ears, removing sutures, putting on bandages, trimming toenails, and all that stuff you shouldn't even be touching. So, let's find a veterinary technician and pay them well, put them in a column in your appointment book, charge for their time." And that's another problem is, people will say, "Well, are you charging for your tech time?" "Hell, yeah." These are valuable people. They have an education. And when I work with experienced, highly trained technicians, I have friends who are VTS, let me tell you what, they blow me away. They are so incredibly knowledgeable. I mean, just stunned at what they know, just stunned at it.

And if we are not paying those people appropriately, then we're stupid. I mean, that's just stupid on our part. And that's about as blunt as I can get it.

It is costly to get really good people, and it is such a detriment if that good person you have if they aren't satisfied and they leave. That is a risk. That's a massive business risk.

Yeah. And the common thing is, "Oh, we can't afford it, we can't afford it." Well, it's sort of like, "We don't have time to train." You make time to train, you make time for what you believe in. And if you believe in paying your people well, you'll figure it out. It was Bond Vet who just came out and said, "We're going to figure out a scale that pays our highest paid technicians $42 an hour."

The highest-paid, they have to ascend to that level, but there's a level for them to ascend. And now you're talking about some of that career path ascension, some of that growth, some of all that. Somebody give them a carrot on the stick that they're going to chase and they're going to get to a level that they can be proud of and just go to more.

Yeah. I've spoken about this for several years, I think probably one of the first talks I gave at AAHA was about pay grades. We tell people, "Oh, you can't tell people what you make. We don't want to talk about what you make." Well, people talk about what they make. Let me tell you what, I've been in veterinary medicine for over 30 years, and I guarantee you, everybody on your staff knows what everybody else makes. They might not know what the doctors make, but they know what everybody else makes in the building. So, if you put pay grades in there, and you say, "Okay, this is a level one person who's just walk in in the door and we're going to train them up from the get-go, and this is their starting salary. But once they pass this skills evaluation, and they've learned this stuff, and they've done this for X amount of months, then they move up to this next pay grade." And then so on and so on.

And at least four levels of those, and I think that's what Bond Vet did. So, at least four levels of those with incremental raises in between, but based on skillset and knowledge and ownership of tasks in the hospital, and moving up that delegation ladder, moving up the responsibility ladder. I have never been a huge fan of longevity raises, because people sit in a practice, refuse to learn a new thing. They might as well just be a tree stump sitting there, and yet you're going to give them a raise every year just because they exist and they show up for work. Well, showing up for work and being engaged in work are two different things. And this goes for practice team members too.

You come to me and you say, "I need a raise." "Why?" "My rent went up." "What did you do to earn the raise?" "Really nothing more than I did from the day one I walked in the door." "Okay, show me some stuff and we'll talk about some money." And so, you have to take your own responsibility. And this is Rebecca Rose and I had this conversation, and we're actually going to do probably a whole vodcast of The Bend about self-responsibility. Because people sit there and say, "I want a raise, I want more money, I deserve more money." Prove it. Prove it.

I do love that we build career paths within our hospital. I think that's an incredibly important tool for us. In my first practice, my staff, all had to take four modules. And one was gold star customer service, one was preventative care. And they had to learn, I'm talking about my reception staff, full-time didn't matter, they could tell you the components of a vaccine and the symptoms of the diseases. They knew the anatomy of the ear, and they knew the anatomy of the anus because we spend an inordinate amount of time talking about years and rears in veterinary medicine. And then they had to learn the employee manual because this is something else, nobody ever reads, they all sign off on. So, they got a test on the employee manual.

And then the preventive care. What are the components of blood work? What are we looking for here? And why? And when they passed all of those modules, they got just this little brass pop print, and they got a raise. Because every single one of them was now much more valuable than they had in the past. And as their manager and trainer, because they got tests on each one of these modules, I was also able to find gaps in their knowledge, and not to go and say, "Oh, I can't believe you don't know that," was to say, "Ooh, I screwed up. I'm your trainer, this is my fault, this is my responsibility to teach you, and I'm sorry you didn't know. So, I'm going to teach you now."

So, those kinds of things set in motion into practices, are ways to elevate staff, but they also make your team so confident in what they're talking about when they're speaking with clients. And that energy is obvious and it's powerful. And so, that client who is facing a CSR, who says, "Well, I don't know if I really need to put my dog on this preventative because it's kind of expensive." And that CSR goes, "Yeah, I get it, I kind of know. And that our doctors just tell us we're supposed to do this." Instead, they go, "Well, let me tell you what, the CDC says, blah, blah, blah, blah, blah, and here's the information from cap C about this, and here's what happens when you don't. And here's how much more expensive it is if you don't."

Going back to the data points, let's look at how much inventory we're sitting on the shelf, costing us money or tying up cash. Because cash flow is king in a hospital, and the more stuff you have sitting on a shelf tying up your money, it's like having somebody up there you're paying to work, who's not producing any work. If you thought about it as labor rather than as a product, and you would say, "This is a technician who's sitting here twiddling her thumbs, looking on Facebook," and it sat on my shelf for six months doing that, something's wrong with this picture. That needs to go.

Some of the data points, we talked about how data helps practice owners streamline their operations, maximize their profits, and this is one of these points where we've kind of sprinkled some of this in, but something that's difficult for practice owners to do, for practice managers to do as well, so many of the PIM systems, they don't have great reporting. So, what advice can you give to, or where can people who are watching this right now, where can they go to find some information about what exactly points they should be looking at? How do they get those points? How do they set themselves up to be able to utilize this statistical approach to management? And what should they expect to learn from that?

There are outside data-mining companies like The Success. Have them do some data mining for you is incredibly efficient. The other thing is if you have a robust PIM system, and I ran Cornerstone for 23 years before... It was AVS when I started running it. That's how long ago that was. But I would think about your practice. I mean, I think this is a hard concept a lot of times for veterinarians and managers is, they're so busy running the practice every day that they don't take time to step back and think about the practice, and think about what you need to know about it. And I had that luxury, I had great people and they knew their jobs, and I was one of those managers who would just sit and think, "What do I want to know?"

And actually one of the ways I started consulting was because of these queries. I wanted to know when PetMeds first came on the market, how much of our market share was being lost to these online providers. And I was able to go into Cornerstone and run some sales queries on products and do comparisons year to year from two or three years past to the current year and find out what was getting lost. And in doing that, what I found was, our team was really excellent at recovery. So, when people were calling prescription products and asking for prescriptions, our team was trained to sway those clients from going there and to convince them to come to us to buy those products because of safety and price.

So, we were able to do that, but we didn't have the opportunity for the EPA products. And we found that we were losing those products because we didn't have time or people weren't giving us the opportunity to talk about them. And we probably could have salvaged those two. So, this was one of the things that I... just because I wanted to know where my business was going. So, if you want to know stuff and think about, "Am I promoting dentistry appropriately in my hospital? Well, let's go and do service code queries." And if you don't know how to do that, you pick up the phone to customer service, because you pay for these support people, and you find somebody who's good, and you say, "This is what I want to know."

We can get so nitty-gritty in this, and let them work for us. Because, I will confess to you that when you start to say, "This is greater than this, and this is less than this," and the queries go on and we're like, "Uh-uh, that's not what I'm going to do for a living." So, I would pick up the phone and I'm going to say, "Here's what I want to find out, you build a query, run the report, build it and keep it on my computer, and then I'll run it anytime I want to." So, we were running a 24-hour hospital, day practice, and then it converted to an emergency hospital at 6:00 P.M. and reconverted back to day practice at eight o'clock in the morning.

We wanted to know if it was worth it because it was new. So, I said, "I want to build a query that says, every invoice that starts from 6:00 P.M. to 7:30 in the morning, I want to know how much revenue that drives from eight o'clock in the morning to 6:00 P.M. the next day." And we were able to build that query. And we found out that, yeah, our emergencies were absolutely driving a lot of revenue the next day in major surgical cases when our surgeons came in, and we then knew that it was worth it. Because some of the nights, you would think, "Oh, my God, I'm just spending a lot of money on staff for nothing," but yet, those major cases were coming in, hospitalized, stabilized overnight, and then operated on the next morning.

So, you can get that granular with data if you have a minute to step back and think, "What do I want to know about this?" So, anytime you think of something in your practice, is it a revenue stream? Is it worth it? "Is my ultrasound paying for itself? Is my cold therapy laser paying for itself?" Let me go and run these queries." It's not hard to do. It's basically a sales of a service code, and looking at your numbers and saying, "Is this paying for itself?" So, outside services like Martins, The Success, are great. They're looking at compliance numbers, they're looking at potential opportunities. You can measure how your staff is doing.

I was working with a practice in your hometown, Austin, Texas, and we had The Success in that practice and we started to do some team training, we got our core values right, we started to do some customer service stuff, and we found by looking at those vet success reports that we were having 25% increase in compliance and revenue within six months of working with the practice and training, getting the team on board. I mean, we didn't change team members, we didn't really change any prices, we just started talking to the clients in the way they needed to hear it, and our revenues went up and so did our compliance for those vaccines and fecals and the dentals.

What gets measured, gets managed, right?

What gets measured, gets managed. It's just kind of, even if it's in the back of your head, to watch it. Somehow or another, those things, once you shine a light on them, you could talk to your team about, say, "Hey, you know what? We're really not getting as many fecals as we did. I don't know what's going on. What do you guys think is going on? And let's pay attention to that. Let's really pay attention to that." And you could do nothing else, but say, "Let's pay attention to it." And you can look at the data, and you can see that subconsciously, people are saying, "Oh, I need to pay attention to that." And the numbers will start to move up.

So, it's a good way to prove that your training is working and that your marketing is working. I'm certain that you guys, of all people, know that marketing, "Is it wasting my time and my money and my effort? Or does this actually make people come into my door and accept services?" You've got to know the answer to those questions.

That's what that marketing is really all about.

I used to say, we would send a reminder out to somebody, they'd walk in our door, we'd give them great service, and then went and touched base with them again for a year. We'd just leave them in limbo out there for a whole year, and the whole time, Chewy, and PetMeds, and Walmart, everybody else is talking to them, talking to them, talking to them. People don't understand that the veterinarian down the street is not your competition. Every business, Starbucks, the department store, the grocery store, the gas station, every business is your competition for disposable income dollars. And we are so concerned about what the guy down the road is doing. I don't care what he's doing. I really have no concern whatsoever what this guy down the road is doing.

I'm going to do what I'm going to do exceptionally well, and treat the people in my practice exceptionally well. What veterinarians don't understand is that they are not a medical facility, first and foremost. Their first and foremost goal is to be hospitable. It is about hospitality and the experience a person gets in there. The second one is education. Teach your clients to be great pet owners. They have a great thirst for knowledge, and they're getting it from every place else but you, and you need to have a system in place to inform them. And then, then, you know what? You get to do medicine. It's number three.

I want to make sure everybody knows where to go to connect with you, what resources that you think they should be following that can help them most now? So, why don't you give them a couple of those notes?

Sure, I really appreciate it. And as you probably can tell, I am very passionate about veterinary medicine, and I love it. And my husband looked at me one day and he said, "I wish I loved what I did for a living as much as you love what you do." And I said, "I do love it, and I really want to help veterinarians be everything they can be and live just the best life ever." So, I write a blog, I have a website. It is dboone, the number two, managevets, and don't forget the S, .com. If you can't find it, all you have to do is type in, "Debbie Boone Veterinary," and I guarantee, you're going to find probably more information than you want to. Because I've been doing this a long time, and there's a lot of content out there in the world that I've written.

But there's a blog on there that I share at least once or twice a month, I write something there. I also have a workshop that is available to practices. Right now, COVID is making everybody a little crazy, so, this is a three-part workshop of communication training for the staff and for customer service. Then the second part of it is conflict resolution and avoiding conflict, mindfulness training, emotional security there in the practice. And the last part of it is dealing with crazy, because that's reactivity, and how we deal with reactivity. So, there's a workshop available. There are multiple talks that I have given out there in the universe. You can find me also on my new vodcast, The Bend.

The Bend has about 10 episodes up, so, it's new, but it is about life, it is about people, not just particularly in veterinary medicine, but in our periphery too, and how they have navigated some of these curve balls that life tends to throw you. And I really felt like it was timely because, during COVID, there was a lot of unhappiness obviously because of the restrictions, but also because of the pressure that people were under, and I wanted them to see that hard times don't last. And there are a lot of people out there who really come through some very challenging times in their lives, not once, not twice, more than that, and they come out better for it.

And so, looking back on it, not a single person that I've interviewed has looked at whatever that challenge was, that bend in the road, and said, "You know what? It was for the best. It really taught me a lot, and it really, now looking back on it, it was a good thing that happened to me, because look at where I am now." So, it's lighting a path to where great things happen for you. But sometimes when you're in the middle of the valley, it's really hard to see the top of the mountain. It really is. So, I encourage them. That's on YouTube. I am also on LinkedIn. So, please follow me on LinkedIn at Debbie Boone, Veterinary Consultant. And also on Twitter, Facebook, Instagram. I don't do TikTok yet. I thought about it a little bit, I went, "No, this is enough. I'm doing enough right now." So, all those links are also on my website.

Thank you so much, Debbie. Everybody who's joining us here, remember to tune in for our interview next week, we're going to be interviewing, as I mentioned earlier, Dan Eisenstadt, we're going to be talking about Terra Real Estate. So, that should be really fascinating.

Also, if you are a veterinary practice owner or a practice manager, did you know that you already have a full-page profile that is currently live at geniusvets.com? It's true, you do. You should go to geniusvets.com/start. There's a little video that'll tell you about it. It only takes about a minute and a half video. We have a full-page profile, you can claim it for free. They're beautiful. They rank really well in Google search results. It's a fantastic asset. It's completely free, with no strings attached. You should go claim it right now at a minimum. Make sure that the information that's there is correct. And we're here to serve you in any way. Thank you so much for stopping by, and we look forward to seeing you next time.