423 - How Online Pharmacies Affect Independent Practices

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 Parita, and I am here with Dr. Andy Rourke to talk about something that is affecting multiple practices all across, I think, the globe, actually, not even just America, and it is how do independent practices compete with corporate or with online pharmacies as a whole.

1:19We got a wonderful mail back from an independent private practice that is struggling because they just feel like they cannot compete anymore. They are a high-touch customer service independent practice who prides themselves in being able to stay modern and to be able to help their community. However, they are seeing more and more of the online pharmacies kind of coming in and they're just feeling like they can't compete with them. And so Andy and I talk all about this. We talk about whether we even should be competing with corporate and online pharmacies. We talk about the superpowers of independent practice.

1:49We talk about what kind of gaps we need to identify, what kind of data we need, and where we should really focus our efforts in this battle that we feel internally. And so if that sounds interesting to you, if you've also been having the same feelings, if you've also been struggling with the same things, you're going to want to listen to these episodes, go ahead and tune in and let's get into it. And now, the Uncharted Podcast.

2:16You 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. Hey, Andy, how's it going? Hello there. Happy Friday to you as we record. Happy Friday, Andy. How are things going? Things are good. Things are wild, but they are good. Man, we are hurtling towards the end of the year, Maria, in a big way.

3:03And so I just, I cannot believe how fast things are going. and the leaves are changing colors here and falling. And it's just, yeah, it's this fall thing is happening. I know. It's crazy because whenever this happens, especially in fall, there's always so much that happens like right after the holidays, but also between Thanksgiving and Christmas, things tend to slow down in a big, weird way. Yes, in a weird way. In a weird way where like communication just slows down, different vacations for different people. You know, like some people take this time off and this time off. So it's like really September and October tend to be, I feel like at Uncharted, at least our go time, right?

3:40January and February and September and October. Maybe January, February and March and then September and October. Like September, October, absolutely. You're like hammered down all the way. Which is interesting because in the practice would be a little bit different. I feel like we were really busy. Well, actually in a weird way around the holidays, but not in a good way, unfortunately. It was a lot of fun. And in the summer, right? Yeah, and in the summer. But that's also why we're geared down at Uncharted is because a lot of people go to conferences in the summer, right? They're all doing the family stuff.

4:08The clinics are really busy because people have time to bring their pets in. Also, I have a longstanding belief that there is a strong correlation between the amount of time human beings spend with pets and the likelihood the pets are going to get injured. Yes, that's also very true. That's also very true. You know, it's funny because we see all these different, I think we've been being in veterinary medicine, you kind of see all these different trends. And one of the interesting trends that we're seeing in veterinary medicine is all of these different trends as far as online pharmacies, all of the telehealth, all of this AI services.

4:43And that's exactly what the mailbag is about today. I'm a little proud of that transition. I felt like that was pretty good. That was good. That was very slick, very seamless transition. I love how you take victory laps at the beginning of the show. That's one of the things I love about you. It's already a home run. You're like, this could not go wrong. No, no, no. We've got so much. I'm really excited about this topic. I know that I'm excited about most topics. I just like to yap a lot. But this one in particular is one of my favorites because I think that we've been struggling with this for a long time.

5:16And I actually did a lecture on some of this at the Practice Owner Summit earlier this year around the powers of the independent practice. But we got a mailbag, essentially, that is very much like that. They're facing the challenge of they're an independent practice. They're seeing what's going on with the online pharmacies. They're seeing what's going on with telehealth. For them, they try to be like high touch, above and beyond customer service, all of these different things. And so they feel like they're, from a customer service standpoint, they try their hardest to meet their clients. However, with all of this that's going on with the online pharmacies, with telehealth, they're starting to feel like they can't really create a competitive or comparable experience to what obviously corporate or online pharmacies are doing.

5:58And so a lot of this, they wanted to get your specific insight on this. They did say, hi, Andy, specifically. And you'll like this. They said your insight and big picture thinking always helps us think through issues. So we'd love to hear your thoughts. I know that was very kind of them. But they really want to know your thoughts on the best move with the current landscape in veterinary medicine. They understand that the corporates and the online pharmacies are not going away. They're just getting bigger and more powerful. So really, the main question here is, how do we maintain a successful, small, independent practice that can do the best by our clients and patients while maintaining the profit that we need to be successful as a business?

6:35Is the cost of doing business to deal with these outside entities taking our time and revenue and we need to pivot or are we being too nice with our approach? What are you thinking as far as all of this? Yeah, that's a very simple question. The answer is seven. Seven? Oh, okay. Cool. Podcast over. We're done. That's it. And the answer is seven. No, all right, cool. I'm just going to go because I will talk about this. Here you go. All right, look, the future of vet medicine is fragmentation. I'm talking about this a lot. I call it vet medicine 3.0. Vet medicine 1.0 was James Herriot. It's everybody's driving around.

7:12The community knows where you live. They come to your house. You are just baked into the village community, and that's what the old school vet was. That was before I was born. That was vet medicine 1.0. That medicine 2.0 is where most of us have been living for the last 20, 30, 50 years in medicine. Brick and mortar, independently owned practice. We all basically do the same thing. We do surgeries in the morning. We do spays and neuters. We do wellness stuff. We do vaccines. We all practice, quote unquote, quality care. We all basically practice the gold standard because at that time, the gold standard wasn't that high a standard.

7:50You know, it was like it was going up. It's always been going up. But basically the difference between very reasonable affordable care and the gold standard, it wasn't that big. The difference was like$2 ,000. That was the space between gold standard and very reasonable affordable care. That's Vet Medicine 2.0. Vet Medicine 2.0 is over. It is breaking and cracking, and a lot of us are still living there. You've got to stop that. It's Vet Medicine 3.0 now. Vet Medicine 3.0 is massive fragmentation. The rules are over. The model has been broken. It is about taking vet medicine that you want to do and that a certain subset of pet owners wants to have and going out and doing that thing.

8:31Vet Medicine 3.0 has got everything from mega specialty hospitals to general practice surgery centers. They don't have a specialist, but all they do is surgery. I was talking about one earlier today. They've got their whole price list online. It says every procedure has preoperative blood work, pain medicines, anesthesia monitoring, and a physical examination. And this is the price you pay out the door. They got a price for cats. They got dogs less than 50 pounds, 50 to 100 pound dogs, and dogs over 100 pounds. And like that's it. It's a full-end price, and you pay it and do it. And that's that.

9:06I've got friends. I was talking to somebody who used to own a 10 vet practice, and she sold it. And now she does house calls, just her and one full-time technician. She told me, Andy, I make more money now doing house calls than I ever did when I owned a 10 vet practice. And my quality of life is radically different. It's house call medicine. It's hospice medicine. It is having a rehabilitation, physical therapy practice. It's having a behavior practice. It's having boarded specialists that go and work out of GP hospitals. I'm sure most of us at this point have seen boarded internists that come around and do ultrasounds or boarded surgeons that come around and do surgeries.

9:44It's like there aren't rules about this stuff anymore. It's about what do you want to create? We've got a friend. She's a longtime Uncharted member. I've had her on the podcast a number of times. Dr. Lily Chin. She does holistic medicine. She doesn't have any phones in her practice. She doesn't have any phones in her practice. She uses off-site reception, and then she guides people to online booking, text communication. They do a ton of that. You can do that. There's that hospital that just got built here in town. They don't have a front desk. You just walk into the practice and then there they are.

10:15And that's how they work with people. And so anyway, it can be whatever you want. And so Vet Medicine 3.0 is here. So I'm going to lay that down first and just say, the first thing you cannot do is say, how do we as a brick and mortar who provides all the services to all the people compete with corporate money? The answer is you don't. You pick a niche. You better have an opinion. And you start to lean into the people that you want to serve. and the work that you want to do. And then you have got to free yourself from the expectations of the old way of, you need to have all the things. You need to offer all the services.

10:50You need to see all the people, the pets, the whatever. You can't compete that way anymore. And so you don't have to. And so anyway, the future is fragmentation. I totally agree with you on that. One of the things that I wanted to point out here is that I think that the main concept of how do we compete with corporate or how do we compete with online pharmacies, that question alone is broken because you are not an online pharmacy and you are not a corporate. So you're trying to compete on a level where you, I think the individual practice owner, the practice manager here, it's really hard to compete with those services because you are not those services.

11:23And like, you will never have the bandwidth to do what an online pharmacy does. I don't think that you'll ever have the bandwidth to do what a telehealth clinic does, even if you had the technology to do it all. So I think that here is where we really lean on the type of services and a little bit of what you're talking about, some of the things that we've seen in veterinary medicine. And I agree. I think so many of these things are super important in how medicine develops. I'm even seeing like mobile veterinary technicians that are doing their own thing, where even technicians are kind of taking their own roles here.

11:51And so we are kind of seeing this fragmentation that you're talking about. And at the same time, I do think that there's some beauty in that because you get to do what you love to do. I just think that from a how do we compete with corporate, how do we compete with online pharmacy? I just think we're playing on different levels. and when we're trying to compete with them is when we fall into this thing where we try to be something that we're not, and then that ends up hurting us more in the long run because we're not the same as corporate and we're not the same as online pharmacies. And honestly, sometimes I think we make ourselves the bad guy when we try to compete with them.

12:21Yes. You can look petty and angry. You can look petty and angry if you're sort of trying to compete in their game. I don't want to play games that I'm going to lose. And so, again, that doesn't mean that I'm not having a pharmacy anymore. It means that I am not going to try to compete with a big box retail pharmacy or necessarily try to compete with someone who's set up to sell widgets. Look, there's a couple ways the world has changed. Number one, I think we should all be looking and being aware of what AI is going to do and how AI is going to work and how we can leverage AI and how we do not want to compete with AI.

12:55You don't want to be someone who's competing against AI to write blogs on the internet, for example. Like that's just, it's a losing proposition. You don't want to be cranking out administrative work as fast as you can when you're dealing with a competitor that's using AI to just send emails and do these things. Like the game has changed. Actually, hold on. Beyond that, some of them have like an exceptional team when it comes to marketing and branding. And like, not just that, but these pockets that I think make it feel like unrealistic. So some of these online pharmacies, like I've seen them where they email clients like, oh, I'm sorry that your clinic charges you$10 to use the prescription from us.

13:36Here's a$25 gift card. And they're sending out emails like that. There's some of these online pharmacies or telehealth places that are sending flowers when the patient passes away. And here the practices, independent practices, like I just sent a card and now like me competing with that online pharmacy that's sending flowers or even like hand painted portraits of your pets, like you are gonna look like the bad guy if you're trying to compete with that pharmacy. You're not gonna make yourself look great when this pharmacy has done so much to try and be that for the client and the individual that at the end of the day, when you charge this$25 fee just to get the prescription, it only makes your clinic look like almost like the bad guy in the situation, right?

14:15And so I think we gotta be careful about thinking that we're competing with these online pharmacies or thinking that we're competing with telehealth when they're vastly different services from what we offer in our practices. That's exactly right. But we need to lean into that. You need to do your own thing. And there are things that they cannot do and you need to dial in and just double down and double down again on those things. So you need to lean into things that independent practices have and can do well. One, you need to lean into the focus and connection with your community. Focus on and connection with your community.

14:47It's about knowing these people. It's about building interpersonal relationships. You can't scale that. You can't outsource that. It's the difference between people going to great clips, which is fine, but going to great clips versus going to the specific hairstylist they go to. Most people are like, I want to see her or him. That's the person. They know what to do with my hair. I've known them forever. They know about my kids. I enjoy spending time with them. I trust them. I'm going to go to that person. there's great power i'm sure in having a mega corporation and having lots of chairs and lots of barbers and things like that but the stylists are not in full retreat they are focused on building that relationship and that connection with those people in a way that doesn't scale and that's fine i think that's what we have to do the big box pharmacy the online pharmacy they're not there in the room with you and the sick pet you it's going to be hard i think to compete in selling a product that is the exact same product they can get at walmart there's just the economics are not right now granted if it's a one-time purchase convenience is worth a lot and we'll come back and talk about that but if it's something that they're going to be on for the long term and it's expensive i think it's going to be very hard to keep that client buying that widget from you i mean honestly think about what commodities out there you buy from small businesses as opposed to large businesses with the exception of some awesome independent bookstores on it if it's a if it's a box product that you can get in lots of places i'm getting it from amazon i'm getting it from walmart i'm getting it from target you know what i mean it's just that's kind of the the way the consumer has been trained.

16:35However, when a pet comes in and they need a product or a service and we are trying to help that pet and we are trying to take care of that pet, sending people away with a piece of paper is a barrier to care. And we know there's actually research in the human side of medicine that shows that when you have a healthcare system and the pharmacy is at the same location as where the person gets the prescription, where they're actually seen and treated, the chances of that prescription being filled are significantly higher, meaning people are lazy and they get distracted and I don't want to throw people under the bus.

17:09But what percentage of scripts do you think you give to clients and they leave and that script never gets cashed in? I gave somebody a script for a heartworm preventative yesterday and like, I would bet you$10 and I don't bet that script is never going to actually get converted into a heart. Like they said that so they could feel good as they went out the door. There's just a significant fall off. I think that's true. How many pets, if you scripted out ear medicines for an active ear infection, how many pets would wait another 24 hours before their pet owner got around to going and getting them the ear medicine?

17:45Why? So they could save five bucks? That just doesn't make sense to me. I think that there is a very strong case for having a pharmacy at a vet clinic where the pet is, where the person is. Let's get this done. And if they say, why come you charge so much more? We are an independent, locally owned vet practice. We do everything we can to stay competitive. And we carry these medicines because we want to get treatment started right now. Yeah. The convenience thing is huge. And I think that we also forget that a lot of these medications, one of the things that we have in our pocket is the service medications where it's injectable meds, right?

18:19Yes. So for example, I have a dog that's really hard to dose orally for his heartworm prevention and for any kind of supplements or any kind of allergy medication. So I'm immediately, if I'm choosing Cytopoint over Apoquil, I'm choosing ProHeart over HeartGuard. I'm choosing the injectable medications because that is what works best for my patient. Yet the clients don't know about that unless we talk about it, unless we advertise those services. And those are services that an online pharmacy can't always give. And you also touched on something that I think is really, really important as we talk about competing with online pharmacies and with corporate structures.

18:52You were like, you have to be the clinic in the community, right? The person that people trust for the haircut. A lot of the advantage that we have is that we don't have to go through so many different layers to approve something. So when the Boy Scouts come through and they're like, hey, would you sponsor this? You don't have to go through 13 different layers of approval to get that. And we see this over and over, I think, in business. One of my favorite companies to talk about recently has been Southwest Airlines. And Southwest Airlines, a long time ago, when they first started, they were the little guy in this big airline industry.

19:25And they only had routes in Texas. And they were like, one of the things that they were trying to do is we're going to have the lowest fare ticket, right? And so this big corporate entities that were part of the big airlines, they were like, okay, well, we're going to price them to match them. because we know that we have enough funds that we're going to be able to like, we only have to have them this low longer than they do because they're a smaller company. However, Southwest, because they're like, oh, I see what they're doing. They ended up working out a contract where you got like a fifth of whiskey through a few different other companies on top of the low fare.

19:57So not only do you have the lowest fare, but now you also have a fifth of whiskey. Stinking drunk when you're flying. Now you've got a little extra from us, right? So naturally people ended up choosing the Southwest piece, but Southwest could only put that into play that quickly because they were a smaller company. They didn't have all of these chains to go through and like all of this process. And that ended up what, what worked for them. They ended up being able to sustain their price and they ended up staying as a company. And now they're one of, one of the few ones that actually survived some of the companies airlines from back in the day did not even survive the ones that were trying to take them down.

20:30And so I tell you that story because I think it's important to remember that one of your superpowers as an independent, private, only owned practice is the fact that you get to make those decisions and you don't have to go through so many different layers of approval. So you can be in the community, you can be in the parade, you can support the Girl Scouts and the Boy Scouts, you can have afterschool programs, you can have these things that genuinely bond your community to your practice. And those are the things that people don't feel or see when they're going through telehealth. And so I think that there is a superpower here that I love that you called out and I love that you're sharing because I don't want to let that go.

21:06I feel like it's one thing that really sets us apart. And I think that we can continue to utilize that along with what you're talking about, the convenience factor, right? That we do have. I think as those two things together would be sort of two major points for me. I think that people are lonely. I think that people are lonely. I think that a lot of people are fairly isolated. I don't think they have a lot of, I don't think they have as many friends as they used to. I think people feel powerless maybe in a way that they didn't used to. I think that it's just hard to get heard or to feel connected these days.

21:35And so I really believe that if you are, if this is your practice and your baby and you are going to be there, I think that if you bond with clients and they see you and they see you as a person and they trust you, I think that people really want to come back and actually see someone that they know as opposed to being a number in a big company database. And again, different people want different things. But I really do think that the opportunity to bond clients and build, especially a clientele, especially if you're an individual doctor, I don't know that that's ever been higher. I think that people tend to freak out in the existential terms like, oh, the clients are leaving.

22:18And I go, but are they or are you seeing your clients like, oh, no, my clients aren't going anywhere, but other people's clients are leaving. And so it's really that like get you got to stop looking at what other people are doing. You've got to stop looking at the big, scary news stories that you hear and really focus down on who walks in the door and what experience do you give to them? And it shouldn't be about trying to compete with. It's not about trying to compete with Walmart, for goodness sakes, or Costco or stuff like that. is that it's about saying, I'm doing this job and Walmart's not here, but the sick pet is here and the doctor is here.

22:55And I want to take care of this sick pet and focusing on that. It's about saying, you know, hey, you know me and I'm making these recommendations. It's about, as you said earlier, integrating into the community and actually saying, look, we're here and we're from here. And I think that that stuff is really important. And I think that independent practices really need to get on the stick right now in terms of convenience. People want convenience. They want convenience more than anything. There's a reason that DoorDash is one of the fastest growing companies in America. There's a reason that people are signing up left, right, and center for home delivery.

23:32There's a reason that Amazon is crushing everybody and they've got Amazon Prime and they drop stuff at your door all hours of the day and night. It's because people really want convenience. You need to think creatively about how you're going to provide convenience. If people come in and you're keeping a very small pharmacy, let's talk to them about going ahead and getting them on your auto ship. Let's talk about getting them on a home delivery program from you and getting that set up. I really don't believe that independent practices have to match the prices of the big mega companies. I think you have to be competitive.

24:08You can't be wildly off. You can't be 50 % more, but I think you need, if you can get within$10 or 10 % of what else is being offered by the big guys, I think that you should be okay with that. I think that you can make those recommendations. And then I think you have to provide the white glove service and go ahead. If you want people to use your online platform or your online portal, walk them through it right there. Have the person who's checking them out go through on the iPad, go ahead and get them set up, provide that support, but try to just to move them gently and seamlessly onto your platform, or at least give them the option and follow up with an email after the visit that says, hey, here's a link and here's the link to exactly what we talked about.

24:52But figure that stuff out so that you can try to grease the wheels and make yourself as easy to do business with as the big guys, I really don't think you have to compete on price. I think there's some things where you say you're not going to be able to compete on price. That just shouldn't be part of your business model. That should be something that we should move away from. And then obviously, we're going to adjust our pricing so that we emphasize the things that are not going away. And I just think this is part of it too. I think that as competing in a retail space gets harder, we're going to need to adjust our pricing so that we're actually, brace yourself, getting paid for our time.

25:26Like that model makes sense to me. There's still the actual patient care that needs to be given. And that's not going to be taken away by AI. That's not going to be taken away by big box retailers or online shipping and delivery companies. It's something that people actually want from us. It's what we're trained for. It's a service that we provide. I just think it's going to be very hard for us to be all things to all people. And I think it's really hard for mom and pops, regardless of industry, to compete on a retail basis. That doesn't mean you give it away. I just, I literally went today and bought two tubes of ridiculously overpriced toothpaste from my dentist.

26:06Because they have this certain kind of toothpaste and they're like, this is the stuff. This is what you need. And I can buy it on Amazon, but actually more expensive on Amazon. It's sort of one of the local dentist, like mom and pop. I'm not saying they make it. It's not artisanal toothpaste, but it is a special dentist toothpaste. They convinced me that's what I needed. And so I actually went over there and I got it. But the thing that bothered me is I don't want to go over there. I want to order it. I want it delivered. But I also want to support my dentist. And so if my dentist could make home delivery of this stupid toothpaste, a thing, I would be great.

26:37The biggest friction for me is the convenience of getting over there and making this purchase. And so I want to support them. I want it to be easier. And that's an area that I think that they could improve. And I think it's an area where a lot of the vet practices can improve. you believe that uncharted is turning 10 that's right uncharted vennere conference is celebrating 10 years and you're gonna want to be there it is happening on january 15th 2027 and registration is open right now unchartedvet.com hope to see you there you touch on two things that i really want to get into when it comes to the action steps for sure and i i wrote them down here because i want to not forget them but one of the pieces that i think is crucial here is you said different people want different things.

27:17And I think that is the crux of a lot of this. There are a few people who are going to want the cheapest prescription. That's what they want. They want the cheapest prescription. They want to do telehealth. That is not your client. And your marketing needs to constantly reflect that, I think, because a lot of the things that I don't see is when you see, when you have private independent, hardly any of them are still promoting that on social media to the point where there's a lot of corporates that are under corporates, but they're made to look like they're still owned privately. And when we see that, the general public does not know that they're privately, independently owned, small local business, that kind of thing.

27:54And there is some of that I do think we could showcase a little bit more online and show that. But I think that a lot of times our marketing has to be intentional and it has to reflect the services that we do offer and in the ways that we do offer them. So if we have, for example, a fear-free clinic, we know that that is one of the things that people come to us for. There's a fear-free clinic. You see it in our reviews. You see it all over. You know, that's one of the things that makes you unique. You're not going to get that on telehealth, right? So when I'm sharing puppy pictures on social media, it's not just a puppy picture.

28:22It's a puppy picture eating a Pupsticle or using one of the high level treats that we have. It's showing that we have the two separate entrances for the lobby. It's showing that we have whatever fear-free tactic that we're using. We're showcasing that in our social media so that the people who are looking for that service can find us. I think it's the same with whatever services you're offering in your practice in in order to get those clients to come to your practice is different people want different things. Make sure you're sharing the different things that you offer. And then I also love what you talked about with the team because, or when you were talking about the online pharmacy needing to be filled out there in the room, that is huge.

28:55And I will tell you right now, as a practice manager, I'm going to get into this in the action steps. This is a very hard thing to actually get teams to do because it takes time. It takes time to sit there at the end of the room and be like, okay, do you have your prescription? Let me order that online for you and walk the client through that. But if you can walk the client through it, the auto ship happens. And I am a big person on auto ship. I love it. I will automatically get all my prescriptions for my pets. All you need to do is sign me up once. So think about the missed opportunity for those patients or those clients.

29:25When they're coming into the door, they're in the room with you. You could sign them up for that, that immediately get it delivered to you. And then it's auto ship. Like all of these things we forget. But if we don't have a team that's doing it, if we haven't trained or prepared our assistants to do it, if we're not leaving room in the exam to do it, then it's going to fall off and we're not going to take care of it. And that's actually what happened to me as a client. So as a client, I went in for my dog's wellness and obviously I'm not in a clinic right now. So it was like the regular average.

29:50I'm going to go in and I went for the appointment and I told him, I was like, Oh, when I checked in, I said, I'm also going to need heartworm prevention. And they were like, okay, great. We'll get you that set up. I went in, we had the whole exam. I went back out. I forgot upon checkout that I had requested heartworm prevention. That was on me. I was like, no worries. He's going back in for, I think it was an adequate injection or something Chewy was going in. And I sent my husband and I told my husband, Hey, make sure to get some heartworm prevention because he's out. And I called and I texted the clinic and I said, Hey, can you guys get him some heartworm prevention because he's out?

30:19And my husband is going to forget. And they were just like, yeah, sure. No worries. We'll add it right now. I think somebody still forgot we left. I didn't get it. And then at the end I'm sitting there, I'm like, well, I still really need this. I was this close to ordering it off of Chewy because I was like, I just need it delivered at this point. I don't have time to go back. It's Friday. the weekend they're not and so luckily i went on their website and because i work in veterinary medicine i found their online pharmacy and i ordered it through their online pharmacy they still got the credit but i am not your average client you like pried the window open and put your money into the clinic let me help you that's that's that's over the top i love that you did that i love that about you pimpers are not going to do that like that's only because you're like that story that's why i share that story look this is the point that i'm making is that people get they get so worried and they're like oh look at what the big box retailers are doing to us and look at what the corporates are doing and i'm like are you capturing charges like absolutely not we completely don't charge for crap that we do all the time and also we don't ask people if they need paracet aside and we don't tell them oh by the way you got 12 months if you give it every month you're due for it now let can we go ahead and put you onto a 12 month refill would you like to just go ahead let's get you a fresh box delivered every six months you don't have to worry about anything expiring you know blah blah blah blah do that stuff but like people don't do that but they chew their fingernails worried about what the corporate is doing and i'm like forget it man look at your own house get your own house in order figure out who you are think about the experience that you're created and like how many clinics have just got like this bad front desk experience people walk in and the front desk staff is picking their fingernails and you know what i and not paying attention or they got phones ringing everywhere, which they could easily fix and sort that problem out.

32:07Like how much stuff could you, that you actually have complete control over, how many things that are completely in your control could you fix and improve in your practice? And you don't. We worry about what the corporates are doing or what's happening across the profession. It's like, look, the profession is not happening in your practice. The profession is out in the world and people, you know, it's funny. So there's a statistic everybody talks about. And they say, oh, you know, we got a problem in the profession. The visit numbers are going down and the price is going up and this is bad. And I go, you know what?

32:42None of that crap matters. If your visits are not going down at your practice, it ain't your problem. And the other thing is like your practice is not a subset of the entire population. Like it's very, very possible. I think it's quite likely that the price of vet medicine is going up because of a small subset of vet practices that are really ratcheting up prices. And I think that they're driving the average up, but I think there's a certain percentage of vet clinics that are really driving prices up, and there's a certain percentage of vet clinics that are losing clients. And so it's quite possible.

33:14It's quite possible that you have a certain percentage of vet practice groups that like this. It's the Disney model. Disney went through a thing recently, and they decided they were going to increase what they charged individuals, and they were just going to have fewer people at the parks. And they've done that. It's been very profitable for them. Yeah, I love going to Disney. There's a lot of people there. I'm just like, you know what? It is expensive, but for me it's worth it. Totally. It's like, I'm going to go spend my money there. There are people who are going to be happy to pay the extra money to get their pet right into the vet as soon as they want to.

33:46And they're going to have a nice hour-long appointment. And they're going to get the best of care and service. And they're going to pay for it. And they're going to think that that's great. And so the fact that there's a national trend of falling visits, that doesn't mean anything to your individual locally owned practice. The only thing that matters to you is what's going on in your house. Are your visits going down? And yeah, you should be aware of larger trends, but only peripherally. Only to the point that you say, you know what, I'm starting to be a little bit worried about weakness in our booking.

34:17Let's go ahead and lean into that forward booking that we keep talking about and not actually doing. Let's go ahead and start to talk about our reminder system. Let's go ahead and sit down with our software and really start to figure out some of the functionality of these texting reminder system that we haven't really deployed. That's the stuff that I'm talking about. Let's talk about leveraging our AI scribes and our AI system so that when Maria comes in and mentions at the front desk, hey, I need to get heartworm prevention, that doesn't get dropped twice. Yeah, I will push back a little bit because I do think that those benchmarks matter.

35:01But I am a numbers person. So of course, I love looking numbers. Only because I do think from a industry standpoint, I think that that's where you start to see lobbying and people moving and especially clients, some of the things with the mid level practitioner role and all of that stuff. Like I think that it's it's clients will start to try and figure out something. So I do think that those benchmarks matter. But I do think that you're right, unless you're trying to solve a the industry wide issue, in which case you need to join those areas that are lobbying for change in veterinary medicine, you're not going to change the industry-wide situation that's going on.

35:31And I do think it's good to keep your eye on those temperatures, like you said, if to keep an eye on whether visits are down. But the full data is what's going on in your practice, right? If we need to prepare for something, that's one thing. But if we're not seeing those visits down in our practice, and obviously we're not seeing the same thing that's happening as an industry-wide whole. And I do think that people get super nervous about those things and so it's important to kind of like calm ourselves down i think they matter i just don't think that they matter necessarily for this particular mailbag but i think this is a good i think that this is a good point i just don't want anyone to cancel us and be like oh but they do matter i'm like no no yes they do matter not for what we're talking about right now the fact that there's a national trend of of visits going down matters to your mom and pop vet clinic as much as the fact that there's a national trend in divorces going up matters to your marriage you should be aware that sometimes marriages go bad and it's a thing that people do should be aware what led them there and what led to that yeah sure but you shouldn't get up every morning and go how's divorce rate going today oh no you know like it doesn't like i need to lower are my prices take care got a better increase the convenience factor is what i'm talking about like it's it's again it's not nothing but i really do think especially in this mailbag this is an independent single mom and pop practice like a single practice owner i think the existential fear of chewing your fingers off i think it has very very limited value i think you You should recognize, I think way more importantly, you should dial in to making sure your practice actually runs as well as it can.

37:19And then you should look at overall consumer behavior outside of the vet industry. Look, people want to book appointments online. They do. People want things delivered to their house. They do. It doesn't matter if the corporate's doing that or not doing that. That's what people want. and I want you to have a great practice and that's where society is going. And so let's keep raising our game. Like let's keep working on the things that we can and leaning in. And then let's be ruthless with our accounting. Let's start looking at our business. What are the things that drive your business? What do people show up for?

37:56What are you good at? And then what are the things that you're not really good at or that are not profitable for you or they require a ton of labor and just don't generate revenue. And like, I think it's time to start killing some of those sacred cows. You know, it's like, well, we have to be open on Saturday. I'm like, I don't know, convince me with the numbers. Like, that's the data I care about is, what do you really see? And so anyway, that's kind of my thing. I love this because we're going to start summarizing the action items here. There were action items in the whole lives of renting? There's a bunch of action items that I pulled out.

38:33I'm glad you're here. talking. I'm, I'm going to, we're going to summarize them. What, what you said is it matters what you're seeing and the data that's in your practice. And I almost feel like this is where I would start for my practice. There is great power and having someone do like a secret shop into your practice and seeing where you might find some of these holes or where you might find some of these areas. Because the truth is like you, everyone's on their best behavior when the boss is around. Okay. Like that's just bottom line. Everyone's on their best behavior when the boss is around, But are you converting new clients?

39:02Are you reminding them about heartworm prevention? When they call, when they come in inside the room, are we walking them through the online pharmacy? You don't really know that experience unless you do some digging, whether that's reviewing the recorded phone calls, whether it's reviewing the records online in your PIM system, or whether that's flat out having somebody come in as a client and share their experience with you. right? Like those things can be really powerful and eye-opening for your own practice along with the data, right? Like how many prescriptions are we even using through our online pharmacy?

39:34Could that be improved? How many prescriptions did we send out through the other online pharmacies? How many are going through our own clinic? Like all of this is data that I think is going to help you decide on your next move and where you should focus most of your efforts, right? Because the truth is you can implement a hundred different things to try and compete with online pharmacy with online corporate, but what's going to really move the needle here in your practice and with your numbers, I think is the most important. Well, we, you know, we just did our medical director summit and we had John Young.

40:03Yeah. Yes. And he, so he's a veterinarian and he came and he talked to the medical director summit and he went undercover. So he went ahead and he picked out an illness for his dog and he did not want his dog to be poked or prodded or anything like that. And so he said, he said her breath stinks is what he was like. Oh, she's got bad breath. And then he called and made appointments with five different clinics and went and took his dog. And it was just that's what he was there. He was talking about the different clinics. You know, one of them was independently owned and a small vet number. And then one was a much independent, much bigger vet number and a couple of different corporate groups.

40:38And he just went and recorded his his experience and his interactions, his thoughts. And he brought that stuff back. And so it was fascinating to see what the experience was. he told this story about first of all he told he told a story about a technician that came into the room that was like so the doctor is going to want to do a dental and they're going to want to do blood work before they do the dental and you know the the estimate for the dental is going to be about seven hundred dollars so you probably expect a thousand dollars total can we go ahead and do the blood work and john was like i i let me i like i'm going to see the let me see the doctor first and then we'll decide but it was like this person walked in without the doctor was like it's going to be a thousand dollars to do what you want to do and then and then there was another doctor that was like she's fine and john was like well why is her breath smell he's like nah she just got just got bad dog breath that's old yeah that's just it and just the different the experiences between the practice was wild and how different it was and so anyway all that to say there's great power in having having people go into your practice and just say like tell me what happened what did they say like just learn that yeah the other thing that i would say is interview your clients and not the clients you're thinking about.

41:46The vast majority of feedback that we get about our practices is from angry and complaining clients. And honestly, those are usually not, they're not your A clients. They're not the clients you serve. The biggest problem that we have in feedback is we focus on unhappy people or negative people when we listen to them. What we don't do is what you need to do, which is go and interview your A double plus client. go talk to the people who love your practice and say why do you love our practice what do we do that that makes you trust us so much that come here so much like what are what are the services we provide how are you treated what was it that that made you realize that you wanted to keep coming here talk to the people who are happy because those are your people there are unhappy people that are going to be unhappy no matter what there's gonna be the people that we mentioned earlier marie you said there's going to be people who show up and they're like i want the cheapest thing.

42:42That's fine. I don't judge that person. But also, I'm not interested in getting their feedback on how I should better run my practice because I know what they're going to say. That's not what I'm trying to do. And so anyway, I think that that type of data gathering, I think that that's really critical. You know, in my practice, and now I feel like you could use AI and do this really quickly. But in my practice, one of the things that was really eye-opening is like I had the team go through and go through all of our reviews, all of our positive reviews and find the common denominators and figure out like what are the people actually saying as to why they love our practice.

43:18So a lot of the things that they pulled out was like friendly, fear-free, like customer service. They explained things, very education, right? Those were the things that like people hung onto for our practice. You could now even do a quick AI search through all of your, you know, reviews and figure out what people are saying over and over again. What are the patterns? Those are what people are finding you for. And that, that I think can be really eyeopening. I love that you brought up Dr. John Yunker's the session, because one of the things that I found most eyeopening from that session at medical director summit was the fact that he went to five different clinics and he actually only received one treatment plan and one follow-up.

43:52And I was like, what a missed opportunity. Like I am somebody who I am constantly talking about. You should be doing treatment calls. You should be calling those unbooked treatment plans, whether it's dentistry, spays, blood works, now even heartworm prevention, or the prescriptions you're talking about. But the fact that he went in specifically to five different practices and was looking for that, and only one of them actually followed through, goes to show you there's probably a lot that we can do within just training our team to follow up on the things that we need them to follow up. So is this more of a structural issue within your practice where we need our team, our veterinary assistants, our veterinary technicians to be talking about the prescriptions we have in hospital, to be walking them through the online pharmacy, to be following up on those online pharmacies.

44:36For us, sometimes when we had outside online pharmacies, our receptionists were trained to reach out to those clients and be like, hey, I noticed this is actually cheaper at our online pharmacy. If you'd like, I can put that order through so that you can save, you know,$10,$15. But it takes somebody actually looking it up, which takes about three minutes. And if your receptionists aren't doing that, you're never going to be able to show the client that. And for the client, they were always super gracious for that. They were like, oh, thank you so much. I had no idea you even had an online pharmacy.

45:01This is how you spread the word. You get your team to actually be talking about the online pharmacy and trying to help the client in the best way that we can, but only if we know where the gaps are, which we only get if we find out from the shopping or the data gathering. So those are some of the things. What other kind of action steps do we need to include here, Andy? Take us home. So big action steps, I think, for me, one, we talked about doing an audit. Are there gaps in your service delivery? Are you missing charges? Are you doing the classic things that hold practices back? Number two, what are the areas that you struggle to compete in?

45:38And what are the areas that you thrive when you compete? I don't want to be in the business of selling blenders because people can buy that blender anywhere. And I just, I'm not going to be the cheapest guy to buy this specific blender from. I would be much more interested in being a hairstylist because I believe that I can create an experience and relationships that people would say, that's my guy. That's who I want to see. That's the person that I trust. And I don't think that a big corporation can come in and pry my clients away from me if I just focus on doing a good job and I lean into those relationships.

46:14I think the key in small business today is relationships, relationships, relationships. And I think it's shifting your business model off of a retail model. That doesn't mean I'm not going to have a retail component to my practice. I am. But the biggest driver for me, it needs to be my time and my services. That's what I need to get paid for. That's what's not going to get taken away. That's what's not, you know, it can't get scaled and blown up and used against me. And so I'm going to do that. And the last thing I would say is we're going to take a look at the practice and we're going to be serious about our efficiency at the practice.

46:48Like if we're going to be profitable in the world going forward, we've got to lean in and pay attention to where is our money going? Where are we spending money? Do we have our labor costs under control? And then are we leveraging our labor in a smart way? Meaning are we utilizing our technicians in a way that makes sense for our practice? Or are they glorified animal holders? Those are things that when it's your money and you're the practice owner, like you can't just take those things for granted. and just because the corporations can be like, hey, you know, sure, we'll have techs holding dogs.

47:22You've got to be smarter than that. You've got to be tighter than that. You've got to be more organized and you have to be more attentive than that. Yeah, I mean, talk about bringing in revenue. It wasn't that AVMA found that like 36 % of your gross revenue can be increased simply by utilizing your technicians, right? Like that's a huge number, 36 % of your total revenue. Like, and that's, we're talking about the individual profit margins on prescriptions, But like, boy, that is such a huge driver, right? Directly correlated to services, something that telehealth and online pharmacies cannot take away.

47:52So I love that you said that. Anything else before we wrap up? No, I think when you think about the world and you think about the disruptions that are happening and how everything is changing, guys, I can't think of a much better business to be in than veterinary medicine. People need, they want the interpersonal relationship. They want to trust their pet's doctor. They want to know their pet's doctor. They want someone there to put their hands on the pet. They have real problems that need an actual solution. And it's not an app that they can download. They need their pet fixed. And that involves a human touch.

48:31AI is not going to pick up a scalpel. And it's not going to build a trusting relationship. Like, we are really well positioned, I think, for the future. And now it's about leaning in and maximizing the human connection because I think that that's what our profession is going to have that a lot of them are not. And so anyway, I'm super optimistic and positive about the future. I am very positive about independent practice ownership. I think that there is a myriad of different ways that that can look. I think that the greatest risk is fixating on what practices look like 20 years ago and trying everything you can to make the modern world fit with the practice from 20 years ago.

49:15I think that's the problem. I think it's time to think about how can you compete? What are you good at? What are you excited about? What do pet owners want? And then it doesn't matter what the model used to be. it's time now to start converting and you don't have to throw the switch, but you need to start iterating your practice and moving towards the way that you want it to be in a way that makes sense. But I'm rooting for you and I'm also optimistic for you. I love it. Thank you so much, Andy. This one was really fun. Outstanding. Thanks for having me. Anytime. This is your show. Thanks for having me on my show.

49:48Thank you. And that's it. That's all we got for y 'all. I hope you enjoyed this episode. I know I certainly did. Thank you to Andy for chatting this through with me. If you can't tell, I am super passionate about independent private practice. I think that we have certain superpowers in those clinics, and I love to see clinics that are willing to use them and figure out where their gaps are and try and grow those areas because we need you. We need independent private practices, just like we need corporate practices, just like we need high touch, high quality, just like we need access to care and low cost clinics.

50:19We need all of it in veterinary medicine. And so I am excited for the future. I want to, as always, thank Andy and all of you guys for listening. And thank you to Dustin, who works behind the scenes to edit our podcast. And thank you to Tyler Herring, who works on our social media and marketing for us. Y 'all, this podcast would not be possible without them. So thank you all so much. And we'll catch you next time.

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