The GeniusVets Show with Dr. Cheryl Roth
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Hello, everybody. Welcome to another episode of the GeniusVets Show. I'm your host, David Hall, co-founder of GeniusVets. We are excited to be continuing our exploration of the trends, the threats, and the opportunities that are facing veterinary practice ownership today, by bringing a top-performing veterinary practice owner to the show. Doctor Cheryl Roth is the owner of Guardian Veterinary Care, a four-doctor veterinary practice in Sherwood, Oregon.
David Hall
Dr. Roth has consistently demonstrated her dedication to practicing veterinary medicine at a very high level, achieving both AHAA accreditation and fear free certification within months of opening her practice back in 2021. So, some really impressive stuff, and I'm just delighted that Dr. Roth is taking some time out of her busy schedule to join us here today. Dr. Roth, thank you so much.
You were one of the practice owners that we had targeted and identified as running a successful, high-performing practice. We reached out looking to get insights from many practice owners to get insights directly from practice owners about the trends, threats, and opportunities facing practice ownership today.
The insights you gave us were really cool! So, I'd like to dive into those here today and give you a little space to talk about them a little bit more. But before we get into all of that, would you mind sharing a little bit about your career trajectory up to this point with our audience?
Dr. Cheryl Roth
I am a 2004 graduate of Colorado State. I initially went into general practice and moved to the East Coast with my fiance at the time so that he could go into medical school. I practiced my first four years in a very rural practice in Vermont. I took on call, did “all the things.” and just got to learn the nitty-gritty of it all We moved to Minnesota four years later, so I got to practice in a much more urban environment at a very high scale practice for a few years. Eventually, I took a step back after my husband finished his residency and went into emergency medicine. A little bit was to allow me the flexibility to work when I could work and manage children at home. My husband and I tried to work opposite schedules so we could be with the kids more. I found out I loved emergency medicine and ended up working in it for the next ten years!
We moved out to Oregon, and I continued in emergency medicine for a while, but I missed the connections with clients, long-term follow-ups, and getting to know people better to develop those relationships. And so I really was excited to go back into general practice. We opened our own clinic about three years ago. I'm board certified by the American Board of Veterinary Practitioners and canine feline practice. So, we really wanted to make it an advanced level of medicine and bridge the divide between general practice and referral institutions.
AAHA accreditation was first on my list, so we did that, followed by getting Fear Free Certified. We are so excited! I love going to work every day; it’s fabulous. I love what I do. I love this profession.
David Hall
It really comes through, hearing you talk and seeing your practice online, it comes through. Opening a practice in 2021, you were at the peak of the upward trajectory of demand for veterinary care. Opening a practice at that time and getting clients at that time wasn’t too challenging compared to the last 30 years. This profession has just bloomed. But, during that same time, practices all over the country were all impacted. I can tell you the number one thing teams were looking for was to hire and attract doctors and staff because they coudn’t even take on any more appointments.
You grew into a four-doctor practice rather quickly! Do you have a secret to share there?
Dr. Cheryl Roth
It’s all about our culture! When we opened, we decided this was our baby. My partner and I wanted it to be an environment where people would thrive, where people loved working and loved being a part of a team. We don’t all have to be best friends, but we want to enjoy what we do together and really love what we spend the vast majority of our days doing.
And so we've really continued to aim for that culture and taking care of people. We check in with everybody regularly. If there's a challenge or an opportunity for improvement, we talk about it right away instead of leaving it six months for review when people don't have any clue what you're talking about anymore. And, so we just, you know, try to make it a really happy environment. We've been very blessed with our two associates. We knew them prior from our days in ER, and both were looking for part-time experiences as working moms. And so we were excited to be able to expand and bring them on! Each of them has amazing insights to offer the clinic. And our staff does, too!
We really emphasize, “It's all about relationships.” And so it's about the relationships amongst the staff, our relationships with our clients, our relationships with our patients in being Fear Free, and really honoring that relationship and that bond between our clients and our patients. That's the most important thing, and we really try to nurture that.
David Hall
I also know you are a VMG member. So that says a lot about your dedication to stepping away from the practice and working on the business and above the business rather than just in the business, and you reflect that.
Huge recommendation to anybody listening who is not yet working with VMG. Fantastic organization.
I want to segue a little bit and shift into diving into some thoughts that you started sharing and your responses to our survey. So we will start with the first question:
What trends do you think will impact veterinary practice ownership in 2024?
Let's start from the top. When you said increase in the use of AI. What are the ways that you're thinking and you're seeing and feeling already that you're finding it useful?
Dr. Cheryl Roth
So just like everyone else, we're kind of exploring these avenues, as they arise, but using AI both in marketing, social media, in writing responses, in responding to our clients, and trying to get those responses a little bit faster and more sustained and trying to say what we're trying to say without having to worry about each and every one of those words. We are finding it is a very useful tool in that regard.
I'm really excited about some of the opportunities that are availing themselves already with some of the urinalysis machines that we can use facial recognition software to kind of recognize what's out there, which may not exactly fall into AI, but utilizing it for looking at radiographs, and just kind of all the opportunities that are coming along. I know there are several opportunities out there as far as AI looking and scanning, even finding little aspirates and masses and trying to get answers a little bit quicker, for our clients who don't have to wait that week to find out what the scary new bump is on their pets. And I think that'll lead to more people willing to do those kind of testing on their pets and find cancers earlier. And so I'm just really excited about what opportunities it will bring to the profession. And I think with any new technology, there will be drawbacks and benefits and just trying to find those things that are beneficial and utilize them.
David Hall
Have you used it at all, with any of the scribing tools yet?
Dr. Cheryl Roth
I have it on my list to do right after spring break to give it a try. My husband is an MD, and they just started using it in their ER. They are trialing right now as we speak, and they are loving it! I’m just trying to figure out how to integrate it with my online software.
David Hall
That's very cool. The next thing that you mentioned after AI was inflation. So, how are you feeling the impact in your practice?
Dr. Cheryl Roth
My perspective on it is probably a little bit shortened. I've been a practice owner for not quite three years yet, but I have watched those prices on things just dramatically increase on medications, vaccinations, the cost of building out a practice, the cost of of loans, with interest rates going up, and then the effect that it's having on our our client base as well, too.
I think it's really that boom that we were seeing during the pandemic, I think, is starting to slow off. I definitely don't have a degree in economics, but I'm feeling that as a practice owner. And so we're trying to find how do we balance the need to pay our employees a living wage, take good care of our doctors, provide the best medicine, and yet not overprice so that we aren't able to take care of all of our patients.
We are trying to settle into the repercussions of what happened from the inflation boom. But leading indicators of where the inflation is going, it's certainly cooled, and it's getting back to where they're saying that they wanted it to go. And they're looking at potentially cutting where those sort of things.
David Hall
Without pulling out the economics crystal ball or anything like that, it certainly seems like that's going in the right direction.
Did you go through an increase in prices even in a short period of time?
Dr Cheryl Rother
Oh, yeah. We have. We've had to increase them every year even just with our costs going up. And it's hard because I feel bad. We increase prices because we want to give raises to our staff members and make sure that they're settled and that this can be a career for them, and not just a job for straight out of high school and move on. You know, making sure that people stick in this profession and stick around is really vital, I think, to being able to continue to provide the care that we want to our clients.
David Hall
This was an interesting one. Nobody else had mentioned this particular note: A higher number of people suing and filing board complaints since COVID.
Dr. Cheryl Roth
I had heard in chatting with some of the state board members that the number of complaints has gone up and just really skyrocketed since COVID. I think there's a sort of a general underlying grumpiness or distaste or just everybody's feeling the stress, still of of what was going on. And, I think it is just kind of overflowing into other areas, and frustration with whether they're not able to get in or didn't have that communication face to face while we were doing curbside type things.
I think it has affected both our clients as well as primarily our staff, and the last thing we need to be doing while we're working so hard and trying to see as many patients as we can and getting everybody the care they need is them worrying about, “Did I say the wrong thing? Did I cover all my bases? Have I covered my butt so that I'm not gonna get in trouble in addition to worrying about taking care of the patient?”
David Hall
Actually, quite a lot of people did mention something along the lines of clients being more active in complaining online, more vocal, grumpy clients, that sort of thing. People’s willingness to, at the drop of a hat, go online and blow somebody up in a bad review for, a lot of times, very unfair things. And particularly in veterinary, it's almost always a very unfair thing. It's it's pretty rare that the practice really did something wrong when you see those negative reviews or whatever.
You also mentioned more demand for fear-free or low-stress handling of pets. I think that there was certainly a lot of increase in awareness among the public of these issues. A lot of people just spend more time when they go home for COVID with their pets and just putting more awareness and sense of necessity on those criteria.
Dr. Cheryl Roth
I think the demand is out there. We have people coming and finding us specifically, and for that reason, there are a lot of stress cuts. Whether there are more stressed pets or it's just more awareness, I think it's debatable. All of our COVID puppies were born in times when we couldn't be as social and couldn't get them out and socialize them with other dogs and other people and and events. And so they're more nervous and more worried coming in.
But I think it's an amazing opportunity. I'm so excited. I've gone through both programs, both the low stress handling and the fear free certification, and I think they're both amazing. I think the awareness they're bringing to the public with better handling and just being conscious of the patient's fear and anxiety and stress that they bring to the room and ways that we can help decrease that are really in improving our relationships even with our clients, in addition to the pets.
We've just seen so many success cases even in the last couple of years. We’re celebrating them on a weekly basis. It’s amazing. There's this little Frenchie who has bit an employee because he was so freaked out with nail trims. And now, six months later, with all the things that we're doing with him, there are no biting attempts and no growling and no grumbling, and he lets you trim nails. The amount of stress, I think, it takes off of our clients, as well as the joy it brings to our staff is is really a a reason to celebrate every day.
David Hall
You know, I want to call a little attention to two things there. Number one, the story overall just demonstrates that you're being effective in how you're practicing care, what you're able to achieve in an animal, and how they're reacting. You also right in the beginning of that, you pointed to something that points back to your culture, that you guys are actively tracking and uplifting and sharing and putting emphasis on these stories of tracking those types of results and congratulating the team so everybody feels that they've participated in something that had an effect in life, and that brings purpose back. And that builds culture, and that helps people avoid feeling burnout and all those other stresses.
Dr. Cheryl Roth
And that's all all generations, I think, feed into that. I know some of our younger generations are really craving that sense of purpose that you need to know that they're making a difference, and not just punching a clock and and coming in because, I mean, these are our lives. We're trading we're we're trading hours of our lives for money. And why not do what you love doing and do it for a good purpose and a good reason why you're doing it?
David Hall
That's it. That is the attitude that breeds success today.
What threats do you think veterinary practice ownership is facing in 2024?
You had pointed out three things here. Inflation, which we already talked about. Demand for higher wages, which I think is tied into that. And then the next one is the increase in number of corporate owned practices. So I'm going to take it back to you, and that is the demand for higher wages. How are you feeling today in your practice?
Dr. Cheryl Roth
You know, I think all of us saw that through throughout COVID that, as we're trying to hire people, we need to offer better wages and keep increasing that in order to staff. When we're maxing out, and we're in a time when our staff sort of has that advantage of picking wherever they want to go. Because for every one applicant, there might be multiple jobs available for them. So that competition is going to raise those prices, right? What do we need to pay?
But, also, I think it is our awareness of trying to keep team members in the profession, and provide them a living wage and making this a career for them, those wages are going to go up. And I think that's amazing. It also is a challenge. And how do we balance that out with not pricing out our clients from being provided the care that they need?
David Hall
These are a squeeze that every prize owner is feeling right now. It's a very real thing. These are real dynamics in the industry, but I also truly believe that these are short-term. And here's why, because there are some real interesting changes in the dynamics that are going on right now. And this exact scenario played out in the pharmaceutical industry twenty-five years ago. So, twenty five years ago, the pharmaceutical industry was going through a massive boom. All these new drugs were coming out, all these prescripts getting super prescribed. There was a huge push for all this, and there were not enough pharmacists, actually.
One of my best friends, his dad owned a pharmacy. I saw this play out with him. He couldn't hire any new grads because the corporates were throwing these hundred hundred and fifty thousand dollar signing bonuses and scooping up all the new grads. Sound familiar? Right? This has been going on. And so, as a response to that, they were bleeding the small independence dry. And in response to that, the schools increased class size, and then they opened up a bunch of new schools.
And then there was a big promotion for, “Hey, become a pharmacist to fill the schools and all of that.” Well, what happened was if you fast forward to today and adjust for inflation, pharmacists today are making roughly about fifty percent of what they were making twenty-five years ago. And the reason for that is all of these pharmacists hit the supply and demand. Right? About fifteen years ago there's a reason I went back twenty-five or fifteen years ago: the market was getting flooded now because of the schools' increasing class size and new schools. The market was getting flooded. And so, what happens with supply and demand? Now, there's a bunch of pharmacists. So wages start to march down, particularly at the corporates that don't quite have the bleeding heart for their staff. And they have more people that are just making decisions based on numbers. Right? And so their wages start to go down. And what is that for a corporate owner… that's profit? Right? So the corporate owner isn't like, oh, let's cut everybody in and make it fair.
Corporate owners like that don't have to pay as high of wages for the most expensive person on their staff. And that's, that's now profitability for us. So what we're seeing today is we're seeing a lot of that same dynamic. There are not enough veterinarians to meet the demand. Schools have just increased their class size, and they're going to build a bunch right now. They're planning on building ten new schools, and those are underway.
And, so that it's going to take probably six, seven years before that really even starts hitting the market in a big way and making any sort of a dent in the supply, economics of this. But if that continues to play out, what's going to happen, you're going to see in about four to five years, corporate realize that, “Hey, this is coming and the supply and demand is going to be that. “ So let's go back and buy a bunch of veterinary practices because a few years after we own them for a few years, the most expensive employee is going to get their wages decreased, and that's profit margin for us. So there's going to be another big wave of acquisition. But to the second point of what you said there, the increase in a number of corporate-owned practices is a massive increase. There was a huge wave of acquisitions during COVID, but it's pretty much cooled off.
. Dr. Cheryl Roth
And really, truly, practice ownership is the opportunity for veterinarians to increase their wages. I mean, it's it's truly taking on that that risk of owning a practice is what allows those wages to go up, which is what's gonna allow some of these sky high loans to be paid off at some point. I think that’s where the concern is losing that opportunity, for those profits to stay within the profession, and support and be able to pay off those student loans.
I still have student loans, and we won't talk about how many years ago I graduated, that are, you know, still kicking my butt. And I'm, you know, got a daughter who's looking at going into veterinary school behind me. So, yeah, I'm and I'm a little bit worried. I wanna make sure that as a profession we don't total knee jerk and say, hey. Let's open a million new veterinary schools and provide all these vets to the area. I think, you know, looking at a recent study that they've just released, you know, the issue truly is retaining staff and retaining doctors and retaining support staff, and not producing doctors and producing veterinary technicians and then having them leave the profession.
David Hall
I think when we see them leaving the profession, it's because not every practice has the culture that you're actively building. And I think if they did, you wouldn't be losing employees like that. The other thing is that we're gonna go through a huge period over the next starting this year, next year, and the year after that. Of all those practices that did sell, most of those practice owners, signed a two to three-year contract that they were going to be in there for an earn-out or whatever it might be.
But those funds had a hundred and eighty acquisition companies, and the majority of them were just like, “OK. We'll buy you at a fifteen to twenty x multiple. And then once we own 60 of these practices, we can sell them at a twenty-five to thirty x multiple to a bigger acquirer.” And that was the whole play on the vast majority of those.
But when all of a sudden the equity markets changed and when the FTC kinda indicated they weren't going to let everybody roll up, roll up, roll up forever, They started blocking certain acquisitions and telling some groups that we won't name to divest part of their portfolio, and those sort of things happen. That told private equity, “Hey, musical chairs is stopping way before you think it's going to, and you can't roll up forever.” So they're like, “You know what, guys? We're not gonna fund the next round of acquisitions.”
And a bunch of these groups now got left holding the bag, and they're facing some really serious hardships because those doctors who used to be the owner, they're the captain of the ship. Soon as their contract's up, they're gone. They're not going to stay on as an employee. And so the other associate vets and people that are in there, they're not really all that happy. I haven't heard too many great stories that they're so happy with the new corporate ownership. I have heard some. Not all corporate's bad, but a lot of them aren't super happy. So when the doctor or the former owner leaves, that's going to be a sinking ship, and it's going give strong independent practices like yours the opportunity to pick up other associate vets or techs and certainly clients that are no longer getting the same level of care that they're used to. So there's going to be a lot of that, I think, in the next few years.
The ability for a smart, well-run independent practice owner to maybe pick up additional locations as they're looking to fire sale. When those private equity funds put their stuff together, they put it together with a timeline. They're supposed to return people's money over the next couple of years, and they're stuck owning a practice they're going to have to sell. So, there are a lot of really weird dynamics there.
What we call opportunity. And that's my segue to the last section here is opportunities
You mentioned increase in AI for client services and diagnostics, which we touched base on in the beginning. But you also mentioned ease of online CE and virtual visits for rechecks, triage, and stuff. I would love to hear where you're getting your CE, what platforms you like, and then I would love to hear you talk about how you're utilizing, tele rechecks and triage.
Dr. Cheryl Rother
Absolutely. I have been a big supporter and fan of VETgirl for a long time, of what they're doing, and really being able to make dinner for the kids when I get home and yet still get that CE opportunity by listening and watching those videos has been really helpful.
All these podcasts are out and available now while I’m driving to work. And in fifteen minute drive, I can still pick up a tidbit of information, something useful to use in practice, has made it really convenient. And as a parent and a busy family, it's much harder for me to get away to go to a three, four-day conference somewhere else. There's a million moving parts that have to be coordinated to make sure that things at home are going okay, in addition to getting there and sitting through CE. Sometimes I don't have the attention span to sit and listen for 10 hours in a day, but it's great to be up an hour or two here and there.
So I think it's a great opportunity, and I think it's bringing more CE available to both doctors and support staff and giving them that opportunity to hear from these experts on a regular basis. I'm the unpopular one who loves Zoom meetings and loves being able to connect with people from across the country, without having to get on a plane and go and visit. I love things in person, too. Don't get me wrong. But I love the convenience and availability to do a lot of those things. And I don't discriminate. I will listen to CE put on by corporations that are sponsoring people, by independents, our local CE, our local Oregon VNA and PBNA, and some of our county groups, which still do great CE locally. And I'm a nerd and always will be, and I will take my learning where I can get it.
I think there's there's nothing quite as amazing as being in person and being able to get your hands on a patient, but there are definitely a lot of questions and concerns that some of our clients will have. Oftentimes, they're just things like, I'm worried. How does this incision look post-spay? Is it okay? And the availability now for people to text in photos and or email them in or send us a video where we just need a quick peek. Nope. That's normal. Or, oh, no. That's concerning. You need to come in– for things that we've already been taking care of. So, problems that already exist, and we know most of what we need to know, but we just want to get that added piece of information. It's really fantastic. It allows us the opportunity to take care of these patients, but without them having to necessarily drive in, find a time, and have all that staffing available to take care of them here in the office.
There are a lot of things I can do in between visits with people who are coming into the clinic to take care of some of these patients. Some of my seizure patients might have had two or three more seizures, and we just need to chat about adjusting their medication. There isn't anything about looking at them that I need to get my hands on, but I need to be able to have that consultation. So we'll do that either through Zoom or just on a telephone call and schedule them that way. And we try to meet that balance between using doctor's time. So we do charge for them, but it's not as expensive as if they're coming in because we can be a little more efficient. And so we're trying to utilize and be as efficient as we can with our time and our space.
David Hall
So it sounds like you're doing a mix of phone calls, maybe they take a photo and text it to you or something. You can jump on a Zoom call.
Dr. Cheryl Roth
Yeah. So we're trying to figure out what situations work best for what, be able to provide the care that our clients need, and really tailor it to what that particular patient needs.
David Hall
Absolutely. Well, I love it. You are embracing the future, and it is one that is in high demand. And it sounds like you're just doing a rocking good job.
I want to thank you for coming and spending some time sharing your insights with our audience. Before we sign off, would you like to offer any parting words of wisdom or advice?
Dr. Cheryl Roth
You know, I just say I encourage our colleagues in practice to try to find the opportunities and the challenges. There's some negativity floating around about being a veterinarian or being in this field in this profession. I'm not a super sunshine kind of person, but I just really enjoy what I do. And I think that there's an opportunity for us to find the positive and really just hang on to that, Remember why we do what we do.
And I, you know, I love what I do, and I love being a veterinarian. And I hope that I can help other colleagues to find that passion again, too, if by chance they've they're losing it.
David Hall
With more independent practice owners who are approaching things the way you are, the professionals will be very, very strong for a very long time. I really appreciate it.
And to everybody who has joined us here today for this conversation, we've got another great conversation coming up right after this one.
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