421 - Tied to the Floor, Banned From Hiring, But Asked to Fix Everything

0:00Ten years ago, I thought people came to conferences for information. I was wrong. You can Google almost any answer in 30 seconds while hiding in a supply closet. What you can't Google is skill. Skill is having hard conversation when you're exhausted, short-staffed, and the person across from you is upset. And that only comes from practicing with people who will tell you the truth when you miss. That's what Uncharted is. On Friday, January 15th in Orlando, the day before VMX opens, we're celebrating 10 years with a one-day conference built around leaders practicing hard things together. You'll get Dr.

0:37Peter Weinstein, the Uncharted team, and about a dozen mic drop talks from people in the community, people you know like Dr. Phil Richmond and Dr. Caitlin DeWild. I'm not going to tell you it'll be easy because it won't. But if you want to do the work alongside people who get it, come and join us. details are at unchartedvet.com. Register today. Don't miss your chance. Welcome back to another episode of the Uncharted Veterinary Podcast. I am your host, Maria Pareda, and I'm sitting down with Dr. Andy Rourke today to go over an excellent mailbag. I just love this question. We have a practice manager who feels literally tied to the floor because they are only given eight out of 40 hours for actual management time.

1:19The rest of it, they are expected to be on the floor. And they are also banned from hiring, which becomes potentially problematic because they have a goal of increasing their productivity from 160 to 180. Now, Andy and I don't really know how they get this productivity score, but they want to know, like, how do I actually do this? Is I set up to fail? Where am I actually going to be able to do this? And so Andy and I talk a lot about managing up. We talk a lot about how to have this conversation. We talk a lot about industry benchmarks and whether this person really is set up to fail and what that might look like.

1:49We talk a lot about actual productivity ideas like how do we increase revenue or become more efficient given the fact that we are not allowed to hire we just talk about so much and I feel like this is such a real thing affecting so many different practices whether you are a corporate group and you are given these parameters or whether you're a small animal practice and in general feel like you are also working your team ragged and not bringing enough revenue but at the same time don't have enough resources to hire another hand so what do you do Andy and I have got you covered So let's get into this episode.

2:22And now, the Uncharted podcast. You show up for pets every day. It's because care is your calling. And it's ours, too. We know it's what drives you to make a difference in the health and well-being of every pet. That's because at Zoetis, hundreds of veterinarians are part of our team, too. working with you to provide science-backed medicines, technology, and practical support to help elevate your standard of care. Learn more at careisyourcalling.com. So this person also said that they may need a trip to Camp Tough Love. And I think that this might be where this question was inspired from. But what do you do, or what does this person do, if the numbers are genuinely impossible?

3:11If they do everything right and they still can't meet that 160 or it can't happen without a body in the building. What's the next step there? You get to choose how you suffer. You know, so one of my favorite sort of things to talk about is in Buddhism, they talk about life is suffering and our great empowerment is choosing how we struggle. And so I say, you know, in this case, in all cases in life, we get to choose how we struggle. And again, I don't know that that's true, but if I went in there and I said, I cannot get to this number. I don't believe it can be done. I truly don't believe that I have been given the resources.

3:47I still want to do a good job because I want to do a good job. That's just who I am. And so I want to show up and I want to do a good job. And also I get to decide how I want to struggle. And so can I get up and go to work every day and just do the best with the people and the resources that we have and feel good about it or that I'm not hitting their number? or am I going to get up and go in and be miserable? And I'm going to say, well, I'm going to suffer by going somewhere else because I feel like the system is set up to fail. And so if I'm not allowed to win, the real question is, well, what does that mean to you?

4:20What does that actually mean for you? If I have to listen every day about how our clinic is not producing and not producing, I'm going to get pretty frustrated pretty fast. If the messaging is, you guys are doing great, you're just not at this benchmark where you can hire somebody else, then I'm going to say, I don't know, can I be happy going to a practice where we book three weeks out and we don't take walk-ins at the end of the day because we don't have the manpower to see them? Maybe I can be happy. And I'll say, well, that's just what it's going to be. And we're going to have the team that we have and we're going to try to get organized and efficient so that we use the resources that we use well.

4:59But at the end of the day, we're going to go home and we're going to be able to be okay with that. I don't know if it's right or wrong. A lot of it really depends on the context and how people respond to you and what your life is like and what your team is like. I love that part, especially because there is going to be at some point for some people, this is really important and they don't want to not meet their numbers. Like for some people, this is a huge deal. This is enough to really think about whether I want to work somewhere else or not. Right. Like if you are really feeling like this is impossible and it's, it's a pattern of they keep, you know, like I've already brought it down to 180 and they keep bringing it more and it feels like if you're truly that unhappy and this feels that miserable, it would be that time to think about, yeah, maybe this particular role isn't for me.

5:40And that's not failure. You know what I mean? Like that, like there, there are some practice groups that are like, we are going to run the leanest ship possible. I'll tell you this, Maria. So I was talking to somebody earlier today and this person had, had worked with a practice group And he said he was an executive up with this group. And he said, it just became clear to me that the CEO, he wanted to follow the Disney model. And I know you're a huge Disney fan, but he was a CEO of a practice group. And his idea was, we're going to ratchet the price up and we're just going to serve less people.

6:15And so we're going to have fewer clients and we're going to charge them more. And that's how we're going to be available and convenient. And that's the business model. That's what, you know, Disney has done that with their parks. They've raised the prices significantly of going to the parks. And the idea is there's a lot fewer people at Disney World now than there used to be. But the people who were there paid a lot more and the park isn't as crowded. So, you know, they're probably happier with the price that they paid. From a business standpoint, you can look at Vet Clinic and say, we're going to ratchet the price way up.

6:43And we're not interested in working with people who can't pay it. And we're going to see fewer people in charge of more. And like, you can make a strong business case for that. I think it's hard to make a moral case for that. And there's a lot of people who would not want to work at a practice where the prices are really, really high. And, you know, and we have to tell people all the time, like, you're not going to be able to afford these services. And so I'm not saying that CEO is wrong. And in the capitalist American model, I mean, business schools would probably say he's right. But I think the people who are here to do the medicine, I think they're going to struggle with that.

7:18And so if there was a system and they were like, hey, Andy, you're not bringing in enough money in this system that we have, that could be a very true business model. And it's also not the place that I want to be. And that doesn't mean that I'm a failure. It's just this is not what I want to do. Yeah. I think there's a fit alignment here is what I was getting at. And I think you hit it perfectly. You described it with all of that because not all of us and not to knock on the clinics that are that model. I think that there's a lot of greatness to that kind of model. The fact that they can practice the kind of medicine that they want.

7:53They have deep diagnostics. They have exams that like fear-free, aha, like white glove, the super high touch customer service. I'm sure they market appropriately so that they're getting the right customers, clients to that clinic. Either way, the whole point is it is a totally different model. And the grass is not always greener on the other side. This is where a lot of people will start to compare corporate and private, right? Like you start to hear, well, if you worked at a private, you could hire and you could probably convince your practice owner. Not always. You could. At the same time, there are pluses and there's, you know, negatives to each one.

8:24So each one has its benefits and each one has its downsides. And so overall, the crux of it all is there is that. If this feels like an impossible metric, if you get there, if you don't meet it, if that means that much to you, if it's going to be super impossible for you to continue to lead this team knowing that you guys are running ragged, just know there are other clinics out there. and it might be a time when we sit down and we look at, do I really want to work here? Oh, yeah. No, I think you're right. And I think you're right. I wouldn't be rash about it. But I think your spirit of curiosity you started with, I think that's key to me is, you know, help me understand.

8:59Like, how do I get these numbers and things? And then the other thing that I would do is, you know, you're reporting at the chain. You're trying to hire someone. They should not be your enemy here. They should be your friend. they should be stoked about you doing what you need to do to be able to hire. And so going to them and saying, I feel like we really need help. You're saying that our numbers aren't where they need to be in order for us to be able to hire. Help me to help you. Like, help me to figure out how I can get this clinic where it needs to be. Will you look at this with me? And try to draw them in.

9:35And if they're like, I don't have time for you, then that's really bad. That would affect how I feel about this. but they should want you to hit the performance numbers that are going to allow you to grow your practice because from this mailbag it sounds like they're doing good medicine it sounds like they've got a good little team it sounds like the doctors are working cases up you know it sounds like they they are doing a lot with a few people it would be such a shame for those people to go uh we we can't win we're set up to fail and we're demoralized and now everybody just kind of kind of leaves And I see that happen.

10:09And it's such a shame when it happens. And so if the regional operations director is worth their salt, they should be cheerleading you. They should be trying to coach you. They should be trying to help you get there. And again, like I said, context matters. Can they give support? They should want you to succeed. And, you know, a lot of how we go forward depends on do you feel that support? And also, do you ask for it? Yeah, this reminds me a lot. You're a Ted Lasso fan, right? You watch Ted Lasso? Yeah. I forget which season it is, but Ted Lasso is a great coach to his team, and he lifts up Nate, the manager.

10:49Yeah. And Nate turns toxic because at some point he's not given, or he feels like he's not given the coaching or mentorship. He was lifted so high as this great coach. Yeah. And like, yes, you could do this, but then Ted Lasso didn't really invest in him a little bit, And he kind of turned into this, I feel like this is impossible. This is toxic, you know, situation. And he ended up, it ended up breaking the relationship a lot. So I do think that a lot of times a leader will be defined by how they lead during the hard times versus how they lead during the easy times. And so when a leader tends to like pull away from these situations and just be like, get to the number that you need to be and see you.

11:27Bye. It's just like that, that can really hurt the relationship. And a lot of the resentment can apply from here. at the same time, if the leader can be like, well, let's talk about this. How can we get through this? Then you know that you've got a pretty good leader and he's willing to help you, willing to coach you. And that might be enough for me to say, well, I think I could do this for a little bit longer. And you're so right. And I hate to say that it's vibes, but in that way it is. It's like, do you feel like you've got somebody up the chain who's rooting for you in your corner? Or do you have somebody who's checked out?

11:57I think Ted Lasso is a really interesting idea here. Because if you remember the whole point of Ted Lasso is this team, this team is put together and the owner wants them to lose. That's why they go and get this guy to be the coach who's never coached soccer before. And so, you know, the whole thing was, we're going to set this thing up to lose. And they're able to kind of pull together and get the support that they need to keep going. But I think that that stuff matters is sometimes when you're sort of set up to lose and you don't feel like the people above you care about you or that, you know, like that's a whole different experience than when you've got somebody who's in your corner saying, hey, these this let me talk to you about how these numbers work.

12:38And again, it sounds like the fact that this person put together a really good message to us and asked really good questions. I hope that they have taken those up the chain and said, help me understand how what these numbers mean. You know, how do I get where I'm trying to go? I think that they have opened themselves up, hopefully, to being mentored, to being coached, to being supported. I think that's all that you can ask for a leader on the ground is that they seek feedback or they seek coaching or they ask, how can I get where you need me to be? I feel like this person is doing that. And again, based on what kind of response and the flavor response they're getting, that would seriously affect me, Maria, in like, how do I want to suffer?

13:17Do I want to keep beating my head against this wall? or not. And if I feel like there's no hope, then I think that that would be really hard for me. And if I felt like, hey, this is challenging, but I can at least see a path forward, I know what would need to happen. I think that could turn the tide for me. We're getting close to the end of this episode here. And so I want to summarize some of these action steps because we've got quite a few. We've talked a lot about getting curious. We've talked about getting safe. We talked about how to have this conversation. We talked a lot about essentially like the game and the numbers and how we can look at those numbers from an investment versus, the cost or the spend of it.

13:50But the real question here that we had is how do I mathematically or operationally lift a productivity score from 160 to 80? Now we stated it's hard for us to answer that because we don't know how your productivity score is calculated. So it's hard for me to answer that mathematically, I think. But just from a productivity or from an operational lift, what are some of the cool things that you're seeing practices do to just be able to do more with less staff? Because they think that this is a bigger bucket of possible items. We don't know what this person's already doing. We don't know what they're not doing.

14:19But I know that there's been a lot of cool stuff. So I'm wondering if maybe we could go through some of those idea generators, in other words, for increasing productivity with a small team. Yeah, so I don't know what's in their math equation, but I would want to. But there's really only four levers that you can pull. So the first thing that you could do, so looking at sort of revenue and productivity in the practice, there's really only four levers that you can pull. The first one is you can charge more. If it's a net profit thing and you are saying, this is the team that we have. And I say, here's why I say this, because I was in Orlando last week and I was talking to this young couple.

14:53So they were married. They are less than one year into their practice and it's a mixed animal practice. And it's just the two of them. And they're trying that. I think they've got another assistant who comes in part time. So it's two and a half people, mixed animal practice. And the wife was asking me, she was like, what do we do? He's working all the time. And I said, well, how, you know, how far out are you booked? And they're like, We're booked three weeks out. He's working all the time, but we're not making enough money to hire this other assistant. And I was like, you raise your price. That's the answer.

15:24If you're working as hard as you can work and you're not making enough money to hire more help, the price has got to go up. In some cases, the price needs to go up. That's probably not the first thing I'm going to think in generally in our practice groups. They usually have the price going up part that's often been spotlighted. Would they like that? Wow. Yeah, it's not going to be a surprising idea to them, usually. So anyway, so you can wait to surprise. Number two, you can work up cases more. So I just did a podcast with Dr. Alex Sigmund, the ophthalmologist, and he says things like, he's like, look, every red-eye dog and cat that comes in the door, every red-eye dog should get a sure mature test.

16:02They should get interocular pressures checked. They shouldn't just get a fluorescein stain and then neopoly backdrops and send out the door. They should get tonometry. They should get a short mature test. There should be a workup. We should be checking blood pressures on our cats. Like there is a quality of medicine that we can put forward and work cases up to say, look, if what is going to drive our ability to bring in more help is a completeness of care, then we can focus on completeness of care. So we can raise prices. We can focus on our completeness of care and how we're sort of working our cases up.

16:34We can get more pets in the door. That's number three. And that's a marketing push. that's usually things like it's not the sexy stuff. It's forward booking. It's getting people on the schedule before they leave for the day. Look at online scheduling. Look at texting because people like to text to set up appointments and things like that. But start looking at that ease of communication. But online scheduling is a low hanging fruit that a lot of people, most vets are not doing this. But guys, this is how the next generation wants to book. But things of trying to get, just get more people in. And the last thing is figuring out ways to cut costs.

17:05And it's really, it's doing a time audit. It's looking at how the people in your practice are using their time and then figuring out what can we do to reduce this time. If your vets are not using AI scribes to get their paperwork done, I think you need to be doing that. If you've still got people, and I talked to somebody this weekend and they were swamped and I dug into what's happening and their technician was doing all of their blood work callbacks. And I'm like, you guys are buried. Why is your tech doing normal blood work and UA callbacks? like these should be emails now. This should be emails.

17:40It should be integrated with your PIM system. You should be using AI to crank these things out. And again, I'm not saying we don't call people when they need help on their pets, but at least the wellness stuff and honestly, even basic abnormal stuff. Guys, it's time to be using emails. It's time to be leaning into AI to take the things that we have said and just to make it into a nice email, right? Not to add content, but to make it into something that's nice to send. But these types of things that are eating up your time, we need to do that stuff to cut costs, increase efficiency. And so really, I think those are the only four levers that you have.

18:14You can raise the price. You can lean into the comprehensiveness of care. You can get more clients in the door. And you can get more efficient. You can cut costs. Those are really the four things I see. But again, which ones I'm going to lean on, that really depends on what that game metric is that they care about. because like that's what I said, if the game is, oh, well, you need to get more efficient here and you go and you and you go and start pushing to work up cases more and raise your standard of care, you're actually hurting yourself. And so anyway, that's why I would say I didn't set the rules.

18:47But if that's how they're going to assess you and your ability to get the help that you need to take care of the pets, those four levers, I don't know which one to pull until I know what their equation is. Yeah, I totally agree with you. I had basically that there's you have four lovers, which are the same. I had two things. You can either increase revenue, because that's obviously what they're looking at. And so all the different ways that you mentioned to increase revenue, or you can increase the efficiency, cut the labor, which doesn't sound like it was really an option. So it means become more efficient with what you currently have.

19:16And I think out of everything that you mentioned, because you said so many different ideas, the only thing that I would add in there is that some of these things, when it comes to efficiency, bringing it to the team and asking, where are you spending all this time? I'm glad you finished up on this. Yes, I think that's so important. You're going to find that there are things that you might not be seeing as a practice manager, that there are actual real bottlenecks going on. Like maybe it's the forms. Sometimes it's as simple as like automating the form to print out at the same time that they check somebody in, or maybe even sending the form out digitally before the clients are even in the building.

19:48So that by the time they get there, they already have the signed form. But something is, it could be as little as that, but all of those little things kind of stack up and they make you a little bit more efficient. and when you bring it to the team, you've got their buy-in, right? Because it's their ideas, it's coming from them, they've got to bring, they're bringing in. So like there's a thousand and one, I think ways that you could probably become more efficient or increase your revenue. It all depends on what you're doing currently. It depends on what number they're looking at and then it also depends on like, what is the team excited about?

20:14Because I think that that's going to be huge too. I think you're spot on. And the part I would add onto that too is like once you understand what is this performance number or what is the actual things we need to do, your team is probably motivated to get more help. And so if you can go to them and say, guys, I really want us to be able to hire, but we are not able to hire until we get this performance number where it needs to be. And I need your help. Can you all look at this with me and help me figure out what are some things that we could do to try to move the needle here? Because I think, you know, I'm sure I'm not the only person who would like to have more help.

20:48And so it seems to me that if you do it the right way, it's not about bashing the corporate group that you work for. It's not about being like, oh, they're not letting us do things. It's just saying, this is the game. These are the rules that have been put forward. We have to get to this place. And if we get to this place, then we can hire. And again, I would confirm this too. And when we were talking about trying to understand what's the performance score, and Maria, you hit on this before too. You're like, what does it mean if I don't hit this number? I think that's the type of clarity that you want.

21:17And I would get them to try to commit and say, so you're telling me if I get to 180 on the performance score, I'm going to be able to hire, correct? Can I hire a technician or is that just an assistant? What is the criteria? I don't want you to hire a CSR for me. Not that they're not great. We need a technical paraprofessional. You know what I mean? But I would try to get commitment on that because then I'm going to go to the team and say, this is the deal and what I don't want to do is say this is the deal and then we do it and the person's like yeah no I'm not I wasn't really I just kind of made that number up like yeah that would be bad anyway but I my hope is the team will lean in with you and you don't have to do this alone but I think you do need clarity so you can tell them what the game is and what they're trying to do and and see if you can get them on board I love it I love all of that sounds good anything else that's it for me Maria thanks for hosting this and doing this with me thank you I had a lot of fun with this one.

22:10I knew we would. Just numbers and productivity and efficiency. It's all the stuff we love. So thank you so much. Awesome. Well, thanks. And that's it. That's what we got. Thank y 'all so much for hanging out. Thank you for listening. Thank you to Andy for joining me for this episode. And thank you to the mailbag submitter who gave us so much detail and such great numbers to work with. I felt like this was such a fun thing to do just because I actually got to sit down and work with these numbers and compare them to industry benchmarks and actually try and figure out from a mathematical and operational standpoint, what does this actually look like?

22:40How can we actually move forward? And I think that we brought up, and especially Andy brought up some incredible points around how to have the conversation, how to really prepare yourself to have this conversation with your practice owner, with your regional manager, whoever might be making these decisions. And so I hope you got a lot out of this episode. I know I had a lot of fun. And I really hope to see you at the Uncharted Veterinary Conference happening January 15. Next year, registration is open today. We have an incredible lineup. We've got Peter Weinstein is speaking, I'm speaking, Ron Sosa is speaking, Andy's speaking.

23:10We have a ton of mic drops already submitted. You're not going to want to miss it. And registration is open right now. So go register and we'll catch you next time. A brand new course is now available from the Uncharted Veterinary Conference team. Don't Get Sued is an on-demand eight module course that we've created in partnership with HR expert Debbie Hill. To help you answer the question, why do veterinary practices get sued in the first place? And what can I do to protect my team? This course is available now for$2.99 and is free for Uncharted members. You can find out more now at unchartedvet.com.