The GeniusVets Show with Dr. Rena Carlson
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Hi, everybody, and welcome to the GeniusVets Show for veterinary practice owners and industry pros. I'm your host, David Hall. Today, our guest is AVMA President Dr. Rena Carlson. We'll discuss Dr. Carlson's amazing career, the trends, threats, and opportunities facing practice ownership today, and I hope we inspire you along the way. Allow me just a moment to tell you a little bit about our distinguished guest.
Dr. Rena Carlson's career has spanned more than 30 years, including clinical work, practice ownership, university accreditation, and academic research. In addition to owning a private practice, which she grew to six doctors, Dr. Rena Carlson was also the attending veterinarian at Idaho State University animal care facility for 28 years. In 2014, she was elected to serve on the AVMA board of directors as district eleven director. In her last two years on the AVMA board of directors, she served on the board of governors as vice chair and chair.
Dr. Carlson is currently the president of the AVMA. And so we're just truly thrilled that she's able to join us here today on the GeniusVets Show. Dr. Carlson, thank you so much.
Dr. Rena Carlson:
Thanks, David. It's really awesome to be here and talk about some of the things that are super important to me. Hopefully, I can share with others ways that I enjoy my career and how I have found a thriving environment for myself.
David Hall:
I don't think of myself as an industry outsider anymore, but certainly, eight years ago, when I came into this industry, I was. It's taken a lot to really understand the landscape, and I've done everything I can to understand all the organizations and the people who are really leading things from the various perspectives.
But what's really helped me along the way is my partner, Dr. Michele Drake. She has an amazing perspective, a long career, and all this stuff. And one thing with Dr. Drake is she will look around and, you know, look at what different organizations or whatnot and has a strong opinion about whether they're going in the right direction, wrong direction, and who she thinks is doing great. And this is why I give all credit to Dr. Drake for pointing me in your direction and saying, "That is a person who is really sharing serious opinions that everybody needs to hear." She has just been so heavy with praise. Having read articles you've been putting out at least over the last year is a fuse in the praise for all you've done.
Dr. Rena Carlson:
You know, we all find our spot. All of this, when it comes to being in private practice and practice ownership truly gave me so much flexibility in my career. It gave me an opportunity to shape how I wanted that to look. It gave me the opportunity to surround myself with amazing team members. That is what drives me to surround myself with the people who help create and drive where we want to go. It's all about helping clients and helping pets. Or animals in general.
David Hall:
Many veterinarians get out of school and just want to practice veterinary medicine. There is a lot in that in itself. There's a lot day in and day out. That means so many professionals throughout the industry pour themselves into this, and they're facing burnout from being dedicated medical professionals and helping dogs and cats. Then, you have some very ambitious souls who decide to take on all the challenges of practice ownership. And there's a lot there. You start out wearing eighty-five different hats, and you have to run the whole thing.
In addition to being a practicing doctor, you have consistently found time and energy throughout your career to give back as a mentor, a committee member, a board member, and now the president of the AVMA. To so many people, just one of those things would be overwhelming, yet you've managed to tackle them all.
Can you share some insight on your inspiration or perspective that has allowed you to accomplish all you have as a practicing veterinarian, a practice owner, a mentor, and so much more?
It seems like you've been able to do that without burning out. How do you do it?
I learned early on how important connections outside of my own practice were and how much those connections could help me.
So let's be honest. A lot of what we do is driven selfishly. Right? 'What can I do to help me and my team?' When I would go out to different association meetings and meet other veterinarians, I always looked at those people because they were the more experienced veterinarians early in my career. And I'd look at them and wonder, how did they get where they are? How can I be more like them? I really like this person's style. How can I emulate that? The more I learned and connected with other veterinarians and very successful veterinarians, the more it really helped me. That drives you and inspires you to want to meet more people and look at things in a whole different way.
The other thing is that I started learning that people in regulatory environments make daily decisions for my practice. So we would look at the state legislature, and they were changing our practice act, which would affect me daily. And I really felt like I wanted to be part of that decision. I wanted to be at the table, at least talking about it. You know? So that was another big driver for me to be able to say, 'We need veterinarians at the table talking about these issues because people outside of the profession are making decisions,' well-meaning people. Still, they're making decisions perhaps without veterinary input.
So, that was a big driver for me to get involved in organized veterinary medicine.
I would bring all that home, and I thought make us stronger back with my team. You would learn all kinds of things about leadership and how we provide medicine better. How do we communicate with our clients better? How do we find those things to offer our clients to facilitate care for their animals and help them treat their animals? So it feeds on itself for me about getting out there, meeting people, connecting with people, and how that helps me bring all that stuff back home and do a better job at home and help my team. I don't know if that makes any sense.
The continuous cycle of learning, connecting, and trying to do better.
David Hall:
So you have all the hats you're wearing as a business owner, your job is to get other people wearing them. But how did you go initially? How did you get yourself enough time and organization so that you could just get out and start start participating in those communities in that way?
Dr. Rena Carlson:
It's a personal commitment. I always say that if you really want something, you'll find the time for it. I don't know if I have an exact answer to how I found the time, but I was committed to it.
When you get positive feedback, you return to your practice, utilize some of the skills you've learned, and instill that in your team. You see your team thrive. That motivates you to work harder and even do better for them. I know people say there are positives and negatives to talking about your team at work as your family, but really, it's about building those relationships. When they thrive, it motivates me to do better.
So, you find the time. As the practice owner, I have to make those decisions and say, 'Okay. I'm going to work really hard right here so that I can block out this time. And I know that when I get back, I'm going to have to pick up some slack as well.'
But you just make that time if you really want to do something. In my world, anyway, you make the time to do it. Also, if you've told yourself I don't have the time to do that, you've already fulfilled your prophecy. That will happen. You won't have the time. I never say, 'Well, I'll never have the time…' I just don't tell myself that.
David Hall:
For anybody who didn't know, GeniusVets has produced the veterinary practice ownership symposium at WVC for the past few years.
This year, Dr. Carlson was kind enough to join our panel discussion along with the presidents of AAHA, VMG, TVC, and PAW Consulting. We had this amazing star-studded ensemble on stage. What we are talking about is that recently, at GeniusVets, we put out this survey to top-performing practice owners nationwide and got a lot of feedback from practice owners.
There are three simple questions, and that's what I would like to focus on here today. I want to get your perspective on these questions. The three questions were: What do you think the trends are that are facing veterinary practice ownership in 2024? The second question was about the threats facing ownership in 2024. And then last, the opportunities for veterinary practice ownership.
From your unique perspective, not only as a practice owner and all that you've done through academia but also being at the top of one of the organizations that oversees everything, the entire industry hinges on the AVMA. From that unique perspective, what do you think are the current trends affecting practice ownership?
Well, I think one of the exciting trends is the continued strong demand for veterinary services. People are actually interested in higher levels of service for their pets right now, particularly pets, so that creates so many opportunities. The public wants good veterinary care.
Another part of the trend is certainly technology. There is so much in technology that not only do consumers know about, but they're also seeking. It can really help us do a better job if we embrace that technology and work to make sure we're using it correctly to provide the best quality care for animals. So, it's not only the strong demand for veterinary services and technology but also a ton of opportunities.
Another trend I'm really excited about is I just returned from the Saba Symposium. We have the most energetic, enthusiastic, smart students coming up the pipeline. They want a great career in veterinary medicine. They're motivated. They're smart. And so I think it's important that we really look at that to help provide a really good environment for them to thrive in veterinary medicine moving forward, whether that's there are all kinds of jobs available, whether that's independent practices and opportunities for ownership, whether an individual might be happier and thrive better in a corporate situation. There are so many opportunities. When I got out of school, there were much more limited opportunities for practice models and where you went to work. So, as believe another trend is the wide variety of opportunities that will be available to future veterinarians.
David Hall:
Going back to your first point, there is strong demand and a higher level of service. I think there are multiple levels to this. We saw a massive spike after Covid, and then yes, over the past year, across the country, on average, the number of invoices was down year over year, but that’s also following the record crazy spike of demand. So overall, demand is still strong. The most recent stat I saw was that an estimated around 70% of pet owners don’t actually even go to the veterinarian on a regular basis.
So, a lot of education is necessary. One thing that has happened through Covid is the difficult trend of there being so much information out there. Everybody has a loud megaphone called the internet, and anybody, anywhere, can be blogging, writing, or sharing their dumb opinions on these platforms. And people are losing sight of who the professionals really are. A lot of education needs to be done for the general public to help them understand that veterinarians are the opposite of somebody who's just trying to take your money. Veterinarians are caring, brilliant professionals who really have your pet's health as their number one priority. With that education, the overall veterinary market can grow so much from utilizing veterinary services.
There's also the high-end stuff that you mentioned, the higher level of service. We live in a world where there's luxury everything. Everybody wants a luxury category of everything. And don't get me wrong—there are still coupon cutters and deal finders.
What do you think about appropriately educating pet owners and offering services that reach all different forms of households?
That's a good point because there are a lot of animals out there who don't receive the care we would like to give them. So, it's definitely an untapped area that we need to reach into and meet them where they're at.
I think that as a profession or a lot of different industries, we just expect the consumer to come to us, and I think it's more important that we go and find where they are. If someone is, for instance, hesitant about vaccines, how can we educate them and help them make the right decision? Like you said, there are so many levels of what people have the resources to afford; all the way down to they really don't have those resources.
So if you've been around as long as I have, when we lived through the "dot com burst or bubble," the 90s and 2008, we were still out there providing veterinary care. We just had to adjust to what people could afford at the time or what they were willing to do. So, I think, as veterinarians, we really need to meet the client where they are at, provide the appropriate level of care, and do the best we can for the animal. There is a whole population of people not seeking care and we need to focus on how we can reach them through education.
Then there is a population who is seeking care, but they either can’t afford it or they stay away because of some other kind of barrier. How do we reach that population? And then, of course, through our specialty services and all the advanced care, there's a population of people who truly are going to be able to, want to, and are willing to go to that higher level of care. So, again, there is a whole spectrum of ability and places where we as veterinarians need to reach those animal owners and make sure that veterinary care is a viable option at whatever level they're able to afford.
As that demand goes up, the cost goes up, and so we really do start losing some of those people to even get veterinary care. We're going to see the demand drop. Like you've said, we're seeing visits down because, in part, cost is going up. So there are so many niches that we can, as veterinarians, find a way to get that care, do what we love to do, provide care, help people and their animals, and still make a living at it. In my opinion, there are different niches that we can find to be able to provide that care.
David Hall:
One of the central themes that I generally try to convey to vets is that the overall role of the veterinarian has changed because of the shift in the dynamics just of us as consumers in society. Thirty years ago, if somebody had a problem with pet care with their pet, they didn't go down to the library and check out a book. You know? They called a veterinarian and asked a question. They didn't go do the research.
But today, because we all have the internet in the palm of our hands, everybody does the research. Everybody has a question, and we immediately go to Google. We immediately ask Siri or Alexa. We immediately go to search engines, and those are just bringing back information that's online.
And so this role of where the veterinarian needs to step into being that educator and information resource so those pet owners who are with the pet all the time are actually getting good information that came from a veterinarian, and that slowly turns them into good veterinary clients. It's not like they're going to start practicing medicine at home.
Dr. Rena Carlson:
And part of that is building that relationship. I hear so often how frustrated we get when someone has done a really extensive Google search on what's happening, and they come to me with all this information. I'm not unhappy with that. I'm like, oh, good. You're really informed here, and this is a great source. You're right.
I think it really leads to very well-informed people. Yes. There are all kinds of places online that you're going to get really crappy information or misleading information. But if you can build that relationship with a person, they're much more likely to really hear you and start taking your advice to heart.
I like little sayings every day to help keep my focus in the right place. One of those is always to just remember and seek to understand. I need to go in first seeking to understand before I start trying to give everybody all my fabulous information. I need to seek to understand where they're at, and then we can communicate a little bit. And I want them to listen to me. I want them to take what I have to say to heart, and I need to build that relationship with them before they'll be open to to listening. Then it’s up to them whether they go with the information I’ve given to them.
But building that relationship, seeking to understand where they're at and why they have those beliefs, and then having a conversation about what other things we can think about.
You also mentioned technology. Is there anything in particular that jumps to mind that you’re advocating people embrace from a technology standpoint?
Well, the big one that's always out there is telemedicine, of course, and we really need to be careful, I think, with telemedicine.
In all the surveys of veterinarians, you see, we all believe that an person exam is critical for us to be able to get an accurate diagnosis, get a a good treatment plan, build a relationship with the client, understand the whole situation, use the tools we have (our eyes, our ears, our hands) to get the best diagnosis.
Telemedicine is another tool we can use. And when you talk about the regulatory environment, that in person VCPR is really critical to be able to help veterinarians do our job to the best of our ability.
Telemedicine is a tool. It's simply another tool for us to reach people. And with our changing society and how we are all looking for a button to click to get the information we want, I think that that's another way for us to be able to reach clients. With teletriage, with follow-ups, and all kinds of things we can do with telehealth.
Beyond that, I think the technology world is just fascinating to me because some of the things I see today, like AI record keeping systems helping with inventory, helping with appointment management, HR, diagnostics, cytology, pathology… I can't even begin to think of the endless opportunities. I just keep thinking if I had this twenty years ago it would be life changing.
But it can be overwhelming as well. I think that's one of the things– it paralyzes us because there's so much you don't necessarily know where to go. And that's where having time to really figure out where are the pain points in my life right now, where are the pain points for my team, how can I make a more seamless, better experience for my client, and really prioritize? For me, personally, doing all the fancy AI stuff with record keeping is life-changing. We used to spend hours typing up records.
As veterinarians, we need to start with what really resonates or even a pain point. Really learn them. But your team has to embrace it. The team has to make a commitment. They have to be invested in it as well. I think starting to just pick a few things that really would make the most impact in your practice is so important because then, once you start, look how great things are now that we've incorporated this technology. Now everybody's going to be eager, hopefully, to find the next one, and your clients are going to say that making that appointment was so easy and they loved it.
I think it can snowball once you start seeing the benefit and seeing your team thrive with some of the technology that can really help us.
David Hall:
I totally agree. As someone who comes from the tech industry and has always been a tech guy, the only caution flag I like to wave is before jumping in to avoid shiny object syndrome, to avoid going down because there are so many bad tech ideas out there.
With AI-backed things, it is moving so much faster than just about anybody understands. It's moving so fast in terms of how quickly it's improving, the capabilities, and all of that.
But I think the other thing is before you really invest a lot of time in systems and additional people and the training and all of that– really just super clearly understanding what the benefits of the technology and a cost-benefit analysis are. Is there evidence that it works? Are there others to look into?
Then hop on in because it really can shave off hours of typing stuff in yourself during your day. Get your time back.
Dr. Rena Carlson:
Find out what the sticky points really are for your team. That could be different for everybody. Right? I mean, depending on your practice. And that's where I would start.
What is it that's the sticky point or the challenge or what's driving my team crazy, adding more time to our day, adding more frustration, and what piece of technology might be out there? Then investigate. You know? Is this really ready for prime time? Is it something that can help?
And then getting the whole team involved. I made the mistake of going to a conference or going to something, and, oh, this is the best thing since sliced bread. And I'd come home, and everybody else is just like, well, this is really stupid. This isn't helping.
The team just doesn't necessarily get behind it. So, again, I think those need to be team decisions and help understand. Because what might be really frustrating to me is not a big deal to everybody else. So what is frustrating everybody, and how do we improve that and help that?
Those are some great trends that you identified. What are the threats that you believe veterinary practice owners should know about, be wary of, and be planning to overcome?
I think the biggest threat is just ignoring how the world is changing. We can't just sit here and say, ‘I'm just going to practice the way I always have, and that's okay.’ Not if you really want to grow and thrive.
And if you do really want to grow and thrive, labor force issues are very difficult. It's not just for veterinarians, but it’s difficult to get teams together. There are a lot of jobs out there for people, and there is a lot of choice for potential employees.
You really have to be thinking about what you can do to provide a work environment that somebody wants to be in and stay. My understanding, and we heard Matthew Salois talk about at the panel discussion is that labor issues are not going to go away soon if you look at the demographics of the United States and the baby boomers moving on to retirement.
So again, of the biggest threats is to just sit back and say you are going to put out the same old ad out for an employe or just keep plugging along without embracing technology and not focus on how your employees or consumers want to do business. Once again, we need to go back to meet them what where they're at and understand what drives a consumer.
As veterinarians, we get in the habit of thinking we're the veterinarian, so people will come to us. But we have to look at consumer trends and what the consumer wants. The 80s, 70s, and 60s are gone, and we need to look at the business world, the labor market, and the economics of today. How do we stay relevant?
David Hall:
We live in a world of infinite choice now. Right? Anything you can think of that you could ever want it's all it's available to you, and there's a whole bunch of companies trying to put it in front of you and tell you about it and whatever it might be.
There's just infinite choice on everything. Breaking through the noise is so, so important, and that requires staying in tune with all that is and putting in the work to continue to change and evolve as the industry moves.
Dr. Rena Carlson:
And one of the things that veterinarians, I think, over the years have been very good at, and I think it's gonna serve us well going forward, is building those personal relationships with clients.
That has not changed. People want to build those personal relationships. They need to feel trust. They need to feel that somebody truly cares, And veterinarians have been very good at that, and so we really need to keep that as the core of what we do. But there's a lot around that, again, in the business world and the economics of the profession that we need to we need to be thinking about.
Let's talk about my favorite of the three topics here. What are the opportunities? Where do you think the opportunities lie for veterinary practice owners right now, this year? What is an action that they can take to really benefit their businesses?
I feel like I'm probably a broken record because I think the threats we spoke about earlier… we need to turn them into opportunities. Right? Or when there are challenges, that's where we have opportunity. We just have to think differently than how we were thinking before.
Again, the opportunities are the technology. Holy cow. What's out there that can make our lives so much better? We have a pretty well-informed public. Right? All you have to do is get on your phone. And in veterinary medicine, honestly, I would say the majority of my clients would come in with pretty good information.
Now, I won't deny that there's a lot of crappy information out there, but some do come in with some pretty good information. So we have really informed people who are walking in the door. They know that this clinical sign they see could be this disease, and that may be what they're focusing on.
But they're already informed of the fact that they will likely have to get some blood work and testing done and probably need some sort of treatment for whatever it may be. I remember early, early in my career, people would come in with a problem no idea what was going on. And, of course, we looked at the animal, did testing or whatever was needed, and they were in complete shock that an animal could even have diabetes or a tooth abscess or all these normal things that, as veterinarians, we think are just everyday diseases.
You know, people were just shocked. And today, I don't think people walk in like that. They walk in with already some knowledge about what's going on. And to me, that’s an opportunity because many times they are already in a more that they know what’s going on and trust their veterinarian and believe the doctor will get them to the finish line or get them to the next step. And, again, back to there's really a strong demand. We have a very strong human-animal bond with society today, and people really have a strong desire to take care of their animals and do the right thing, and they want good veterinary care.
What do you think the industry if you're gonna pull out your crystal ball as you've got this great unique perspective and insights from the positions you've had from your experience, what do you think the industry looks like for independent practice owners in the next five to ten years?
So I'm kind of already seeing it because at the bigger meetings, I get to talk to a lot of people, and we're seeing really innovative business models like cooperatives, which can create teams coming together.
I think we need to think of one of the reasons people are veterinarians are shifting to relief work right now is because of the flexibility that provides them. So how do we pull them back into the fold of independent practices and being regular part of independent practices, but provide that flexibility.
When I got into practice, you worked Monday through Saturday, and then you were on call on weekends, and that's just what you did. There was no other option. I mean, we did have a cooperative with our other clinics in our city, so we weren’t on call every weekend. But what are those innovative ways that we can job share and create flexible schedules using a team-based approach so that we are not just left out there doing everything by ourselves?
There are some really smart people out there who will continue to look at really neat business models and use the technology. I was not usually the first adopter of technology, but I watched it really closely because I wanted to see how it came out or what the new product was. I wanted it to be out just a little bit before I jumped in to get some of the kinks worked out. But I think we have some really smart, innovative people who are not afraid to use technology and incorporate it. And that's pretty exciting to me.
Do you have any programs or initiatives you want to make sure veterinarians and people know about right now that you think are important in moving the industry forward?
So we haven't talked a lot about this, but back to the tight labor market right now, retention of our important staff is just critical, and building that culture within a workplace starts from the top. And so AVMA has a lot of resources. We have our workplace well-being, modules on AVMA Axon. We have Journey for Teams, which is an amazing tool in order to build that inclusive environment and help recognize different cultural differences.
Again, back to meeting people where they're at, making them feel included and belong so they want to stay in your practice. There are a ton of things around building a culture that can be so helpful, particularly for independent businesses, because you're constantly looking for those resources to help you as an individual.
Another thing that I think is important is reputation management. We launched a reputation management toolkit a year ago or so ago. So, as good as much as we try, as good as we are, sometimes that social media storm just happens, and you really need some help in the moment to figure out what to do when getting blasted on social media. For AVMA members, our reputation toolkit management is jumping into a whole other world of mentorship. I think mentorship is so important. We have amazing, super smart new graduates, but there's a bridge between academia and getting out of school into practice.
And it is so important to figure out what that looks like. And that's definitely a two-way street. The new doctor has to drive that mentorship as well as leadership, offering support from the mentor in the practice. We have mentor vet and mentor vet connect on AVMA.org This is another really important resource because, again, it's not easy to hire a veterinarian right now, and new grads are an amazing resource to really help build somebody's career. And competing in that world, I think it's important to help understand there may be these huge signing bonuses and reasons why new graduates are drawn to certain jobs.
But it's important to really convey that first couple of years in practice is investing in your entire future. And so I feel like if we can help them have a really strong first couple of years, that sets them up for success for their entire career instead of a really marginal first couple years and then jumping around to different jobs trying to find where they really can thrive. Conveying that is super important, and really working on that mentorship piece for our new grads and setting them up for success, for long-term success, not just that immediate gratification of a big signing bonus.
So lots and lots of things. I could go on and on and on about all the resources with AVMA, but I just recommend everybody go to AVMA.org and start poking around to see what's out there for them.
David Hall:
I think that's great advice. Everybody, go check out AVMA.org, poke around, look at the programs. Is there a good resource there if people know what they're looking for but they're not great at navigating and maybe finding and navigating websites and finding all the little niches and everything like that? Your good chat on there, someone they can reach out to, help them navigate the programs?
Dr. Rena Carlson:
There's definitely contact us. If you log in to AVMA.org, you can actually go into the membership part and find who your local leaders are, and they're going to know a lot about what's happening at AVMA and maybe direct somebody as well. At AVMA, we collaborate with all of our state organizations, and we have two delegates from every state. We have two delegates from every allied organization as well as the board of directors. If you go on there and look at membership and your volunteer leaders, you will find that person who is in your state and is there to help you as a veterinarian. And they're gonna be pretty knowledgeable about all of the resources. And if they don't necessarily know, they're gonna know the person to direct you to.
Any parting words of advice?
I just want to say I'm really excited about the future. Once again, I think we've got some really super smart, innovative people who are working hard. We have some super smart future colleagues in our veterinary schools right now, and I think they're going to meet the challenges. I don't think we should ignore the challenges, but I really think we need to see ourselves in a really positive light moving forward and see ourselves as professionals who are really compassionate.
Our motivation is to help people and animals, sift through all the negative stuff that we see out there, and focus on how we can help. It's one of the things I always try to talk to my staff about:
Here's a barrier. Here's a problem. But stop and think, what can I do right now? What can I do? Don't stop and think about all the things you can't do. I think if we have that attitude as a profession, we will continue to thrive.
David Hall:
Thank you so much for coming today, for sitting down, for sharing some of your wisdom, and for answering our questions. It's really obvious that you have had an amazing career through this industry. Seeing so much, navigating different positions, and sharing that perspective is very, very valuable. So, thanks so much, Dr. Carlson.
Dr. Rena Carlson:
Absolutely. It's been delightful talking with you, David. I really appreciate you.
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