Why Hard-Working Veterinary Practices Still Struggle: Fixing Finances, Retention, Marketing, and Leadership Gaps

So good evening everyone, and welcome to tonight's Veterinary Business Institute's May Summit: Why Hardworking Veterinary Practices Still Struggle: Fixing Finances, Retention, Marketing, and Leadership Gaps. I'm your host, Dan Disha, and I'm so glad that you're here tonight with us. This session is for the practices that are working hard, staying busy, doing their best for clients and patients, but still feel that pressure around profitability, retention, marketing, and of course, leadership decisions. So we are going to look beneath the surface and identify where effort alone is not enough, and what needs to change so that the practice can grow in a healthier and more sustainable way.

Now, a few quick housekeeping notes to help you get the best of the session. Yes, we are recording, and you will receive a replay link after the event so that you can share it with your partners and colleagues. But do not let that make you passive, because the real value is happening here live. So go ahead and use that Q&A button for questions that you may have for the panelists. I'll pick them up and we'll have them answered either along the way or in a dedicated Q&A session more halfway through the event. Or else, use the chat for conversations, reflections, or just your general comments. I have my eyes on both the feeds and well, I'll do my best to weave in those comments and questions as we go along. Right.

Now, before we get into the panel here tonight, I want to quickly highlight the "Veterinary Business" Podcast. This is where we continue the conversation, like tonight, across core pillars of practice success, profitability, patient retention, clinical innovation, operational efficiency, veterinary brands, community engagement, industry trends. I mean, the list goes on and on and on. New episodes are released every Thursday at 6:00 a.m. Eastern. If tonight's conversation is useful for you, this podcast is a great next place to keep learning from leaders across the veterinary business and practice growth. To find us, just go ahead and search for "Veterinary Business" Podcast on your favorite streaming platform, and do give us a subscribe if you don't mind, and stay tuned on that.

Right. And of course, I do want to extend our gratitude towards our platinum sponsor for tonight, Equi Marketing. Equi is the veterinary practice growth partner trusted by clinics and practice owners around the world for over 15 years. Now, their work is built for veterinary professionals who want fewer wrong fit clients and more of that right fit pet parents. So how do they do that? Well, they focus on SEO and visibility, also conversion-focused websites and content and social authority. So helping practices show up where pet parents are already searching, turning visitors into appointments, and building trust through consistent content and campaigns. Now, we will hear more from Equi a little later down in the program.

That being said, right. So here are the five main points we are going to work through tonight. And as you can see on the screen, the important thing here is that these are not separate problems, right? So a financial issue can become a retention issue, a retention issue can become a marketing issue, marketing issue can expose a leadership issue. So we're going to keep connecting the dots, and let's meet our panelists who will guide us through this discussion. Right. First up, we have Mary Limay. Mary is the founder and consultant behind Limay Veterinary Consulting. She brings more than a decade of experience in veterinary medicine, with a focus on leadership, operations, financial performance, team well-being, and of course, clinic systems. She's also a national board-certified health and wellness coach, which gives her a very unique lens on the hidden drivers behind burnout, retention, and of course, sustainable practice performance. Mary, thank you so much for being here with us.

Happy to be here, Dan. Great. All right. And then next up, we have Lila Stone. Lila is a veterinary marketing consultant and marketing advisor at Equi Marketing, the leading digital marketing agency behind this podcast, and also for veterinary practices. She helps clinics of all sizes, from solo practitioners to multi-location hospitals, grow through strategic results-driven marketing. And tonight, Lila will help us look at why visibility, client fit, retention, and ROI have to be aligned with the real capacity and goals of the practice. Lila, welcome to the panel. It's great to be here. Fantastic. Right. And now we also have Shannon Cameron. Shannon is an RVT and certified veterinary practice manager. She brings more than three decades of experience helping veterinary practices improve profitability, operations, and sustainable growth.

Through her work as a coach and consultant with Profit Solver, she focuses on financial modeling, pricing strategy, smarter systems, and stronger margins. Shannon, we are grateful to have your financial lens in this conversation once again. Hi, Dan. Thanks for having me. Absolutely.Right. And joining us as well is Dr. John Yonker. Dr. John is a veterinarian, founder, consultant, and speaker, and he's the founder and principal consultant of VetLaunch. He has helped clinics build stronger, more resilient practices, and he has also grew Common Companion Vet Co. into two thriving locations. So tonight, he's bringing a very practical leadership perspective on what it really takes to balance clinical priorities, business realities, people, and growth. Dr. John, thank you very much for joining us.

Thank you, Don. Happy to be here. Great. And of course, finally, we have Ronald Sosa. Ronald is the founder of Synapt. He has more than 20 years of veterinary medicine and leadership experience, and his work focuses on neuroinclusive leadership, burnout cycles, workplace strategy, and of course, coaching. He's also the host of Left Unattended podcast, where he explores leadership, burnout, and neurodiversity. Ronald, thank you so much for bringing this perspective into tonight's discussion. Yeah. Thanks for having me. This is going to be great. Yes, indeed. So with that, I'm going to stop sharing the slide deck for a bit so we can make this feel like a real conversation, and I really do want to get a quick pulse on our attendees here, so I'm going to launch a very quick poll.

Here we go. This is the one. So let us know how you're feeling here. Where is your practice feeling the most pressure right now? Now, by answering this, it'll help us align the conversation a little bit better to your needs. So, the options are profitability, or is it team turnover, or is it marketing inconsistency? Or perhaps leadership decisions or unclear direction might be a problem. Or is it all of the above? So the poll is on your screen right now. Poll in so that we can align the conversation a bit better towards your concerns. So we got profitability and leadership decision, along with all of the above being in the lead right now with team turnover at the end over here. Right. We're going to keep it out for a couple more seconds.

Okay. Now someone just equaled out everything over here. Team turnover, leadership decisions, all of the above. Everything has become a problem. I love this. Right. Now I'm going to share the results with our panelists here. So all of the above, really. Our attendees here tonight have problems with all of the above, and that's great because you are in the right place, and I really do hope that tonight's discussion will help you turn all of these problems into solutions. Or at least get to the first stage of that. Now with that being said, thank you very much for polling in. Really appreciate it. Keep the engagement going. Ask away your questions that you may have as we move along.

Now, let us begin. My first question is to you, Mary. You hold a rare combination, veterinary consultant and board-certified health and wellness coach. Can you share a moment in a real practice where the financial numbers looked fine, but the vitality signs told you the team was already in trouble? Over to you, Mary. Absolutely. Thank you, Don. So actually, this is something I see in most practices. When I'm looking at team vitality, I'm thinking about capacity, clarity, connection, communication. So I had one particular practice that I'm thinking of right now that they were seeing kind of a lack of growth. So they were financially healthy, but we were stagnant in growth, really below industry standard of new client numbers and when we looked into that, so I'll dig into why that was for a moment and why that was connected to the team, that actually was a reluctance to schedule.

Mm-hmm. So there was a combination between maybe the team trying to buffer the workload and some- Mm-hmm ... a lack of clarity on the scheduling protocol. So kind of a twofold barrier to getting new clients in the door and helping to grow the clinic. They also had some cultural concerns, a lot of team dynamic challenges, and that- Mm-hmm ... ultimately started with leadership, and it was some role clarity confusion in leadership of, I think maybe what we see more than once in veterinary medicine, where we have an owner and a practice manager, and we're not really sure where the boundaries are of what the manager can do and what- Mm-hmm ... they need to run by the owner, what the owner wants to be involved in, what they just share the vision for.

So there was some frustration at the top with leadership, and that obviously was picked up on by the team. There was also some distrust, I'm going to say, with the team, and underutilization, and- Oh, yeah ... that underutilization of the team ultimately then causes another problem of a bottleneck. Mm-hmm. So there was a lot to unpack in this particular clinic, and you look at the breakdowns of kind of all the above that I mentioned, of the communication, the clarity, the connection, the capacity.All of those areas of the clinic were struggling. There were no job descriptions, but most often we see job descriptions that haven't been looked at in five years plus, if they do exist.

Mm-hmm. So really missing the clarity, connection, and utilization of the team, I think were some of the big vital signs that we noticed right off the bat. And these vital signs always show up before those financial numbers start to change. And I think the way I like to look at that is those numbers are like the profit tells us what the clinic can produce- Mm-hmm ... but the team vitals show us how sustainably the team can continue to produce at that level. Mm-hmm. Now you mentioned that you saw these team vitals before it showed up on the statements, right? What did you exactly see? All these issues are-- What is the first thing you saw? What is the first signal for all of this?

Yes. So looking at the new client numbers- Mm-hmm ... that ultimately, as those decreased, the clinic was not growing over time. So as we were tracking clinic trends, we were actually decreasing significantly in clientele. And we know with normal attrition, we have to at least keep up with the industry standard of new client numbers. So- Okay ... we start to see those little breaks in the system that ultimately start to show the impact on the financial numbers. Appreciate that. Okay, give me a second here. Yeah. So that's how new client numbers not showing up really shows up inside your clinic. Now I want to get outside the clinic, and ask Lila about what that looks like from an external marketing perspective. So Lila, most veterinary practices that we talk to are busy. Some of them are booked out. Social medias are active.

But the owners still tell us marketing isn't really working. What's actually going on here? Oh, I talk to veterinary offices all the time, and what I'm seeing is, and I've seen this across hundreds of practices, is busy is not the same as growing. And that's where the trap is. A practice owner looks at the schedule, they see it's full, they see their team's running hard. They assume marketing is doing its job. But when you start pulling those numbers apart, three things will show up. First- Okay ... their case mix is wrong. For example, it's full of nail trims, quick rechecks, these little procedures. They are not the things that are high value.

They are not the dental procedures, the chronic care cases, the real dive into the revenue, the things that are going to be bringing in, keeping the lights on, really. Those are the things that are underrepresented. The marketing is creating the volume, but it's not creating value. Mm-hmm. Now, the second thing is the new client pipeline. Usually doctors take a very shallow look at it. They'll look and see they're busy, but they're not, and they're seeing new patients are coming in, but they're not taking a deep look at it. They're not looking at what is a new client versus a returning client. For example, Molly has gotten a second dog, and they see a second new patient. Well, it's not really a new patient. It's the same pet parent with a second animal.

Then the referrals- Oh ... they would've likely happened anyway. So those are not actually new patients being generated by marketing. And so when they're looking at that, the number of new patients that are coming from marketing is smaller than the owner assumes, and so they think marketing is working. Now, third, and this is a big one, most practices don't really have the marketing strategy. They have a marketing to-do list. Someone's doing some SEO somewhere. Somebody's doing some social media over there. They might run a few Google ads. There might be a Yelp listing somebody set up a long time ago. But none of it is tied to their financial goals, and that is the key.

You have to have a plan. You have to know what your team's capacity is. What is your long-term growth plan? Almost nobody I talk to is consistently tracking this. I ask them, "Okay, what is your new patient value? How many new patients are you getting?" They don't know. what's actually moving the needle. So when an owner says marketing isn't working- What- ... it's usually they're feeling the gap between activity and outcome. Activity is real. The team is booked out, they're busy, but it's not bringing in the money. And honestly- Mm ... when it comes down to marketing itself, if your team is already overwhelmed, adding more marketing and more patients is going to cause more stress. So when it comes to marketing, what do you really need?

You need the right patients. You don't need more nail trims. You don't need more quick patients. You need patients that are going to be filling your books with the high ROI patients. Mm-hmm. And that is where marketing comes into play if you're doing it right. You don't want more clients just for the sake of volume. You need the right clients, the right services, that are going to grow the practice, and grow your finances, and make sure you're taking advantage of your team's capacity and you're making your financial goals. When that strategy comes in, the practices grow. Excuse me, I just need some water. Of course. You wouldn't believe I talk really to me.

No worries. But that's where strategy comes into play. The key is having a marketing strategy that ties it all together. The practices that grow predictably usually are not the ones that are doing the most marketing. They're the ones that are doing the right things in the right order, tied to clear goals that really understand what they're actually trying to accomplish. Appreciate that, Lila. Hold on here. Where's my timer? I don't like this timer going red for too long, so that's why I had to stop it. But yeah, appreciate that, Lila. As you mentioned, the wrong case mix, it might be one of the most underrated points that you made over there, because we're not really looking at that. We're not considering that as an issue with marketing.

Perhaps we are taking it as a given. We are getting these kind of people, that's who we are treating. But it's really possible to get your ideal clients if your marketing strategy is aligned with that. Now, before we do move on to the next question, Mary in the chat asked: What is the current industry standard for new clients? Sorry, Melanie. Melanie Gentry. Melanie, nice to see you again. Asks, "What is the current industry standard for new clients?" Mary, would you be able to answer that real quickly? Because I think you mentioned it. Yeah. I recommend that clinics have between 25 to 30 new clients per full-time doctor. Okay. Lila, what do you think about that?

I totally agree. Okay. And not just new clients, but the right clients. Oh, okay. Check. There we go. All right. Now, my next question is to you, Shannon. You spent over three decades inside veterinary finance, from independent hospitals to AmeriVet at scale. So what's the most expensive blind spot that you've uncovered, the kind owners had no idea it was draining them until you showed them the math? I love this question. I agree. Love the question, too. I would say the biggest blind spot is assuming that your services that you're producing on a day-to-day basis, your common services, that they're actually producing a profit margin. We might have set our prices 10 years ago.

We've done 3% to 5% price increases every year, but we're really not monitoring what that does to our profitability. If you are just raising as a percent each of your services, if it was already losing money and your expenses are raising at the same level at which you're raising your prices, you're still losing money on those services. I think the reason that's a blind spot within our industry is we often price in our industry with what we think is fair or acceptable to clients, not what is actually profitable for the hospital. We don't actually dig into each of our top services to see if they actually are driving revenue. We just try to do more of them.

So you talked a lot about what happens if I'm at capacity, but I'm still not driving profitability. My problem with that is the things that you are filling your books with, if 90% of them are being done at break even or at a loss, you're not going to have a profit margin. Doesn't matter how many more of them you do, you're still losing money on each of them. I have a really simple example, and it's funny that Lila brought up nail trims, because that's one of my examples. I had a hospital that I did this year. Well, actually, it was in 2025. We were tracking their 2024 numbers, and they had done over 4,000 nail trims. And when we broke down what they were charging for their nail trims, which was $25, which felt good to them, it felt like an appropriate level, it turned out that their break-even point was in the $31 range, and if they wanted a target margin on top of that, they needed to charge around $39.

Kind of broke it down for the owners, let them make the decision. They decided to sort of rip the Band-Aid off. Nobody likes doing nail trims in hospitals anyway. They went to $39, knowing that they were going to lose a few clients. Well, they lost a few, but it was less than 10%. They drove $43,000 in additional revenue in one 12-month period based on raising their prices, raising that one price to the appropriate level. So if you have 100 of those services that potentially are losing even $3, $4, $5, if they're not profitable, and they've got that much of a loss. If you're doing them 100 times, 1,000 times, your exams, your vaccines, those kinds of things.

If those are all loss leaders for you, you can't recover it on the big stuff. I see it all the time where a hospital's like, "Well, I'll make it up on our surgeries," or, "I'll make it up on our diagnostics." There's only so much loss that you can make up, so you have to kind of find that balance between my shoppable items that I'm willing to take a loss on. But to me, a nail trim's not a shoppable item. It might be to the clients, but we shouldn't be doing that at a discount. Really, I would argue that a lot of veterinary hospitals shouldn't be doing them at all. Let the groomers handle them. But if you're talking to scale, this hospital was doing over 4,000 of them, and they were losing $10 every time they did it. So it turned out to be a huge oversight on their part and made a huge difference. That was just one of 47 that they changed, and they swung from a no-low practice.

So what we do is we don't focus on doing the totality of your service offerings. We do your top 100 or so services. We focus on those. We generally only end up touching about 45, 50 of them. But generally with huge bottom-line differences. I mean, yeah, $43,000 a year. That is- On one thing ... on one thing. On just nail trims. Yep. Amazing. Shannon, before I let you go here, I'm just curious. You mentioned fair versus profitable, right? Mm-hmm. Yes. Yep. Is it really that fair to not be profitable? I would argue, and I have this conversation with hospitals that come to me at a no low or break even, they're barely making any profit at all, and they say, "Well, I want to be fair to my clients." Okay.

Well, if you can't support your business and you end up shuttering your business in three years because you've run out of working capital, how is that fair to your clients? How is it fair to your team? How is it fair to you? So I always try to tell people, look, know what your costs are. Know what a reasonable profitability margin is. Everybody has a different profit margin target, right? Do I need to expand? Do I need to hire a new vet? Do I need to build a new practice? Everybody has a different reason for where they want to be. Know what that is, set your prices appropriately for that goal. Mm-hmm. Take the anxiety out of it a little bit. There's too much guilt in our industry.

All of us, probably everybody on this panel can attest to that. As an industry, we are guilt-ridden, and that's very obvious in the way some people price. Check. And what I'm understanding from this is really that guilt is coming from a misunderstanding almost of the business side of things. I just think we're an empathetic group of people, and we want to be available to everybody. And my conversation with clients all the time is there are different levels of practice for a reason, right? There's high volume spay and neuter clinics for a reason. There are non-profit veterinary clinics for a reason. Then there's high-end referrals, spec ER practices.

Mm-hmm. There's got to be something for everybody, but each of those independently has to have a different business plan, profitability plan. Check. Thank you very much for that, Shannon. Yeah. I loved where that conversation was going. Perhaps we will get back into it as we move along. So definitely the number one thing our audience can start reviewing, check if your treatments are profitable. Not just breaking even, are profitable because as Shannon mentioned, that started shifting in my head. You got to be profitable to be fair to your clients in the long term if you want to sustain your business. So, with that being said, Dr. Yonker, my next question is to you.

So take us back to a real decision at Common Companion, where the data pointed in one direction and your instinct pointed in another. How did you decide, and what did that teach you about leading from numbers alone? So, as a practice owner, I think the vast majority of practice owners actually don't look at numbers really at all, in a kind of very scary-- So to say that someone leads from numbers would be quite an outlier, and maybe the people on this podcast would be a selection bias towards leading with numbers because they're here in the "Veterinary Business Podcast." What I typically see is the exact opposite. Everyone freaks out around April because they find out from their accountant how much money they did or didn't make.

And right now, even though we've been declining in visits since 2024, I think- That's right ... the third quarter of 2024. The alarm bells didn't really start ringing until maybe last year, and then now even louder. And a lot of it is because people just met with their accountants. Because they don't have proper monthly financials. Shannon had mentioned the break even for that nail trim was $31- Right ... and the vast majority of prices in veterinary medicine along the services are completely made up and arbitrary. And people don't want to acknowledge it, but it's because the prices are not based in a mathematical reality based off your expenses. It's pretty simple to figure out a break even knowing how much your labor costs, you know how much you're open, and how long a nail trim costs. And so then you can apply a margin effect on top of that mathematically. However, to be confident with your charges and your fees, you need to know that your expenses.

And people get overwhelmed. They see literally 2,000 charges in their practice management software, and they say, "I don't know where to start." It's like paralysis by analysis, but really the top 100 accounts for the vast, vast majority of all the revenue in the practice. I will say on an expense basis, as a practice owner, I typically think much more about expenses in a recurring manner than I do on a revenue basis. People get overwhelmed. They see a P&L, and they see so many line items, and they don't really know what to do. And so then they say, "That's for other people. That's for my accountant. That's for my practice manager. Me, the owner, I'm a veterinarian.

It's noble for me just to see the next patient." But for most owners, they really only need to look at four line items on the P&L. One is cost of goods sold, which is kind of your pharmaceutical lab cost. The next one is your staff payroll, so your hourly workers. The next is your associate payroll, and the last is your overhead. And if you can look at those- Mm-hmm ... four buckets every single month, then you don't get in a scenario where your break-even point for a nail trim is $50. Because you made decisions on your expenses that then have implications on your revenues. That makes sense. And so people also get overwhelmed when they see an entire year elapse on expenses, and then they're like, "Well, what do I do kind of going forward?" It's like, well, you could have made decisions, little tiny micro decisions over time that were quite easy to manage, but you have waited an entire year to elapse before you have taken action. And so now, right now, in the macro environment, a lot of independent owners are freaking out because theirNew visits are down, their client retention is down.

And I think one of the big things is because we confuse marketing and advertising as the same. That's right. So marketing is all the ways a company can stimulate demand, of which one of them is advertising. And if we raise price, to Shannon's point, just indiscriminately, we just take the dial and go 9%, and we don't commiserately increase the value, then we're actually doing negative marketing because we're doing the opposite of stimulating demand in our practice. And also the cost to acquire a new client is a lot more expensive than it is to retain the one that you already have in your practice. And so how do we do that? by building systems. Way off topic, but I wanted to flip that question because actually it's not that owners lead from numbers, it's that they absolutely don't lead from numbers.

Okay, check. I appreciate that, Dr John. Now, before I let you go, with regards to expenses and your framework of really thinking about the numbers, right? Looking at expenses more than the revenue and making micro decisions monthly. Can you give us an example of what that looks like, perhaps? Because I really want it to sink into our audience. If your accountant does not provide you your financial statements by the 15th of the following month, you need a new accountant. Right. And that's simple. The P&L needs to be ordered in the AHA chart of accounts. People get overwhelmed when they see that. Your accountant will not. If they don't even know what the AHA chart of accounts is, you need a new accountant.

Sure. And so then why do we need a chart of accounts? So that our P&L looks like someone else's P&L, and then we can benchmark it to know how much should my cost of goods sold be. Cost of goods sold, your pharmaceutical medical costs, that should be 20% to 23% of revenues. I can get my P&L, I can literally do the simple math of my COGS expense divided by my total revenues gives me an expense, and then I know my cost of goods sold is over. Why is it over? I either bought too much. I either may have had to buy something at the last minute that has a huge quantity, like the minimum order is 25, and it's a box of heartworm prevention that costs $1,000, and I ordered it in the last month, so it's no big deal. But it also could be shrinkage, or it could be like Shannon's point.

There's not a pricing thing, and that's why my cost of goods sold. So there's a lot of reasons why, but it causes you to investigate it. Then you go to payroll. Easy. Why is my payroll over? I either have too many people, or I'm paying them too much- Mm ... as a function of my revenue. That's a lot harder to change than order less or fix your pricing. Oh, yeah. Right? Because that can be painful. And the last is overhead, which is literally everything else. Kind of the garbage can thing. So that would be your PIM subscription, your insurance, your rent. All the things get lumped. And those are decisions you made in the past, and they're much harder- Sure ... to undo.

But some of them are more discretionary, so advertising would be a very discretionary number on your thing. But the problem is, the less money you spend on advertising- Yeah ... the less revenue you make, and so there can be a vicious cycle there. But sometimes the only way we can fix our overhead is by growing in revenue, because these are previous decisions that we made. So really, owners only have to think of four things and then get curious about why. And to do that at a time interval that allows you to make strategic decisions within a couple of weeks of the close of the month. Check. Thank you very much for the elaboration there, Dr John.

Right. Definitely, we got the outliers in the building, so it's great that you are really speaking to them and giving us the chance to change for the better, to not be afraid of numbers, taking it slow, taking those- The same brain that can understand immune-mediated thrombocytopenia can understand a profit and loss statement. Love that. Of course. You should not abdicate the most important thing in your business to someone else, because you, quote-unquote, "can't understand it," or it's for other people. The same brain that can understand these things, it's actually simple math. I went to business school, a top 10 MBA school in the United States, and I was terrified to go, and I realized it's not a secret club in business. There's no secret source of information, that the same brain that I got through vet school can also understand these business concepts.

In fact, I would challenge that and say it's actually easier to do veterinary business. It's hard to do leadership and managing people. That's way harder. The actual numbers, the expenses, that is way easier than it is managing people doing the technical aspect of veterinary medicine. Check. And that's one of the biggest topics that we are going to uncover through our discussion, leadership. Thank you very much for that, Dr John. Now, Ronald. Yeah. You've spoken openly about your ADHD and later your autism diagnosis. What did you start noticing about veterinary workplace and your own leadership that you couldn't unsee after that? Yeah, I think the first thing that comes to my mind are the behaviors of our team that we consider unwanted.

When I first started in leadership, I very much followed the rule of a lot of consultants out there, which is if you have somebody with high skill and poor fit, fire fast. And I have since retracted that. I am going to go against the grain here, and it will be controversial. I actually don't believe that to be true anymore. I think when we've got somebody who is highly skilled and poorly fit, we need to figure out why. Why all of a sudden are we a poor fit? Because somebody who, like me, is carrying around cognitive load that is a lot higher than the rest of my team, then we've got to get curious about that. I think that we should be hiring for skillRight?

That is definitely important, but I don't think anybody comes to their place of work to actually be malicious. I think we're driven to poor behavior. So oftentimes what I see is there's an unmet need in the practice for poor behavior. People don't feel seen, they don't feel heard, they don't feel validated, which is a big one, for their experience, even when it doesn't match our own, or they don't feel nurtured. And I don't think that we, as leaders of the practice, need to be able to give all of those needs at one time, but we do need to have the resources available for our team when they need them. So, number one is I see the unwanted behaviors being toxic, and I really want to just dismantle the belief that any person in the practices is toxic. I think people are a match or alignment for one another, and I also think that people who are, quote-unquote, "toxic," may be holding more than you realize.

When we look at some of the stats, the brand-new stats that are coming out here, in the UK, they published their study last year for 2024, and I think the Royal College of Veterinary Surgeons found that 29.8% of veterinary professionals resonated being neurodivergent. Right? That's already one and a half to two times more than the general population. Mm-hmm. I've talked to academic researchers out of Australia, like Dr Jodie Wilson, amazing person. She's seeing stats as high as 50%, those are not published yet, and 70% in our emergency practices. So now we talk about mental health, we talk about burnout, we talk about resilience, we have to have in mind our neurodivergent professionals in our buildings, because it is very different when you are masking, which I know we'll get into a little bit later today.

But when we are masking and putting on a performance, as I call it, to appear normal, dampen down our natural wiring, that takes a toll. We're working a whole second full-time job on top of the job that we're doing, which is already dealing with a lot of stress, a lot of compassion fatigue, a lot of dynamics between teams. It's a whole other job on top of all of that. And so the resilience of just take a break, take an extra day off, take a vacation, doesn't cut it. We need to actually figure out the cognitive load of our workplaces. And what I have seen going in, I still dip my toes in practice twice a month. I'm a veterinary assistant at a local practice in my area because I like to stay in practice. I like to know what's going on.

I went and worked at this practice, and as the veterinary assistant, we had a patient come in, a foreign body. It was a little bit more urgent. The client didn't want to go to emergency, so we wound up cutting it there. I don't normally jump in with surgery, but I said, "Let me figure out how I can help prep." I get to the area, and guess what? The clippers are on one side of the treatment area, the scrub and the alcohol are on another side of the area. In the drawer in front of me, you have catheters, but the male adapters are in the other tower. And then the fluid bags are in surgery, but the fluid lines are in the overstock cabinet. The amount of cognitive load that not only do we need to memorize where everything is placed, right? For somebody who's neurodivergent, who has maybe some memory differences, somebody who has object permanence, which means I don't always remember things that I can't see or where they belong.

It takes a lot more cognitive effort for me to remember and physically run around and efficiently, losing time on servicing our patients. Right? So we can streamline our workflows really, really well. I call it the toilet paper principle, because when you sit down to use the toilet, it's a very vulnerable moment, right? That toilet paper better be within arm's reach, otherwise we're feeling vulnerable. When I go to do a service in the vet practice, everything I need for that service should be within arm's reach. So when I was prepping that patient for surgery, everything should be at that prep station. The clippers should be there, the alcohol and the Clorox should be there, the catheters, the fluid lines, everything should be available to the individual in that moment. Right?

We do the same thing for our surgeons when they walk into the surgery room. All of their instruments are laid out and unpacked in front of them. We can do that for a lot of our workflows, and we just need to start looking at the amount of cognitive load that it takes to run some of our workflows, and honestly, if we start being more neuro inclusive to the people in our practice, we open up efficiency and accessibility for everyone. Ronald, how do we identify this neurodivergency within the practice? What kind of conversation are we having, and how are we going to identify it properly? Yeah. This is the insidious part, because most of the people don't know.

So if we consider that 30% of our practices, or people inside our practice are saying they're neurodivergent, we need to think about who is not saying they are. Our practices in the practice are dominated by females. We know that females are underrepresented and underdiagnosed because they don't present the same as the male counterpart. The two times a female is likely to get a proper diagnosis are two times in their life. One, when they've had a child and they're seeking support and help for their child and go, "Wow, I'm actually dealing with the same thing. I've been overcompensating." The other time they get properly diagnosed is during perimenopause, when all of their coping mechanisms, scaffolding, all of their emotional supports have changed because of the whole fluctuation of hormones. And so if we're seeing 30% on paper, I think there's a lot more, and the part of masking is that we'll never know. And maybe they'll never know until the need becomes so great that they find out.

Mm-hmm. Okay. I'm sorry, I feel like the timer just stopped you mid-thought. Please continue. It's okay. No, I think until somebody's fired, the need is great enough then to seek diagnosis or to seek, "There's something wrong with me." I can't tell you how many veterinarians and technicians and CSRs come to me after they've been fired. I've been called the difficult one. In fact, just last year, I moved locations from the corporation that I worked at because I was considered the difficult one, because apparently asking questions about processes is considered difficult. And then when I stopped asking questions and did things wrong, I got asked why I don't ask enough questions. Right?

We've got to stop looking at the behaviors that are considered unwanted, and recognize and get curious about why and how people process information. Check. Appreciate that, Ronald. Wow, what a conversation. And truly, just I think last week I had a similar conversation with Dr. Amber Parks regarding neurodivergency, and that was also a real eye-opener. Personally, as well. I just had her on my podcast. Oh, that's great. So, yeah, if anyone is interested, Vet in Your Business podcast is place to go and have that conversation. It was very eye-opener, definitely. And there were a lot of things that we can do about it in that episode as well. But anyway, besides the point, thanks, Ronald.

Now, Mary, most leaders assume burnout shows up as people complaining or quitting. What are the quieter, earlier warning signs that high-performing teams hide especially well? Yeah. So you mentioned it. Two of, I think, the most commonly talked about signs of burnout would be the outward negativity, right? Mm-hmm. The negative comments about the client being late or not bringing their pet in soon enough. But I think what isn't talked about is more the lack of focus, right? So the changes in performance with a particular employee. Maybe they're suddenly running behind in appointments or having a hard time finishing their charts. Perhaps they are having more kind of communication misses, or they're expressing that they're overwhelmed a little bit more often.

Mm-hmm. So there are a lot of things that show up as performance issues. It could just be even a general decline in follow-through. Because like I said, one of the really commonly missed burnout symptoms is an inability to focus. Lila mentioned earlier being busy but not productive, and I think that's another thing that happens when somebody's in burnout. They may resort to checking emails and deleting emails out of the inbox and calling back the clients when there's a long list of clients that need their lab results. So the difficult piece of this is when burnout shows up as these performance issues, we manage it as a performance issue. Mm-hmm.

And I'm not saying that accountability needs to go away, but I do believe that, even like Ronald's mentioning, we need to lean in with a little bit more curiosity. And I've seen this especially with a new hire in a clinic, especially when they are not new to the industry. So I actually just had this happen in a clinic. New hire came from another clinic, burned out because the other clinic environment kind of put her there, and thought leaving and coming to a new clinic would change that. And when it didn't immediately, and we were having some negative performance issues, we were immediately jumping to discipline. And I think when we're not paying attention to that, then we start an attrition problem with our staff, and they don't make it past the 90 days.

But instead, we were able to kind of pause and identify and have a curious conversation. I like to start with just asking, "What do you like best about the clinic? You're a new team member. What's really stuck out to you? What are you liking best?" And it's kind of a flag for me if there's nothing that they can identify with that they're really enjoying. And the Gallup engagement surveys, they purposely use the exaggerated language of- Oh, yeah ... "I have a best friend at work," or, "What do you like most?" Because that's really how you get somebody to have a thoughtful response versus saying, "What's going well?" So that's kind of why I lean into asking, "What do you like most?"

And in this particular instance, we did have a really hard time coming up with something. And then the conversation shifts to, "Here are some of the things that I've noticed. And we brought you here for a reason, and you're a valuable employee. We want to support you. What is going on and contributing to these objective things that we have seen in these first couple of weeks?" And this new employee actually broke down in tears, and it's heartbreaking, but also gave me goosebumps when we were able to identify this wasn't a performance issue at all. And now we have a new way to manage this. So I'm hoping that the more we get away from, like Ronald said, these unwanted behaviors are just bad and bad people and people that just strive to be these difficult employees and more towards curious conversations, the better off the workplaces are going to be for everybody.

I had one other instance of an employee that in a clinic that was constantly having communication challenges.And we put her on a performance improvement plan, but often those are done and there's no tools given. So we actually provided very specific resources, documents for this employee, and check-ins after they were completed, so that she could have communication tools to use in those moments where she felt triggered and would normally have an outburst that maybe would formally get her in trouble. Appreciate this. I'd love to add onto that if you don't mind, Tom. Oh, go ahead. Go ahead, Ronald. I think one fact that we need to be aware of for an autistic person in practice, when they are burned out, they oftentimes lose knowledge and skill.

So we can see, to Mary's point, we see a regression in skill and a regression in knowledge, and we don't get curious enough to ask, "You've always done this fine. Now why all of a sudden are you slipping up?" We have labeled them as unmotivated, they don't care, whatnot. We're placing the wrong label and not getting curious. I just wanted to make sure that was thrown out there, because there is a regression in skill and knowledge that needs to be replaced when we are back outside of the burnout. Check. And before we move on here, another question from Melanie that was really great over here. Advice for HMs trying to manage things, hiring managers trying to manage this.

Mary, do you have any advice for our hiring managers? I think that question was actually for Ronald. Oh. My apologies. Speaking as a neurodivergent himself. I just saw it. Ronald, would you like to answer that before we move on? That's a really nuanced and probably a whole another hour-long conversation. Okay. But the short answer is- I'll agree ... and if I can self-promote for a moment, is I wrote a book about-- It's called "Rewriting the Rules: A Neuroinclusive Leadership Model for a Human-Centered Workplace." And it's all about looking at our systems, reducing cognitive load, and trying to create a more neuroinclusive veterinary practice. Check. There we go. Reduce that cognitive load and inclusivity. What a great conversation. I'm just so excited about this today because I'm learning so much already from every one of you. So I hope our attendees feel the same.

Now, Lila, owners often blame retention or operations when clients don't come back. But you've said marketing plays a bigger role in retention than most people realize. Where's that connection? Okay, this actually ties into something John was saying in his last answer. Definitely. It is a very misunderstood part of the veterinary marketing. And what happens is marketing, a lot of people think it stops at the first visit, and it doesn't. When the thought is, "Okay, marketing got that person to my door. Okay, marketing's done." But that is not the case. What we need to do is-- Marketing plays a role in retention. And if you think it stopped at the door, the battle is lost before it even starts. So here, let me talk about a client we worked with last year.

Okay. If you looked at this practice from the outside, it was world-class. They had a great reputation. Their schedule was full. And honestly, they were doing a lot of the things right operationally. Mm-hmm. But when we started mapping out the client journey, what we found out was a new client booked online, comes in, has an amazing appointment, everything's great. They pay the bill, and then crickets. Nothing happens after that. There was no welcome sequences, no follow-up communication. They weren't getting reminders. For example, they were told their pet needed dental work three months out, no follow-up. None of this was happening. There was no effort to reengage when that pet disappears.

This is where we're losing patients out the back door. And that's not an operations failure, it's a marketing failure because the marketing system stopped doing its job the second that appointment ended. And this is the part owners are missing. The marketing directly impacts the retention in four major ways. First, marketing controls the expectations. Your website, your ads, your reviews. If they're all promising this high-touch, white-glove experience, and then the client walks in, they get this 12-minute appointment, and you've created disappointment before the relationship ever began and had a chance to grow. Second is those first 90 days after that appointment.

The welcome emails, the post-visit follow-ups, all those reminders, the education of what that pet needs. That is marketing, and most offices treat that as an afterthought. They're worried about other things. Yes, the other things are important. I'm not putting that down, but so is the follow-up, because that is where it's going to be bringing that person, that pet back for the follow-up and creating a long-term relationship. Third is reactivating lapsed clients. Every office I talk to, or almost every office, has hundreds of patients that they haven't seen in 18 months or longer. And when you have somebody that it's their job to go through, "All right, who hasn't been in?" And they're calling them, they're reactivating. There is so much ROI there.

When those patients are not being reactivated, you're losing them to somebody else. And we really encourage our clients to have that person. It's their job, having those systems in place. And fourth, referralsHappy clients are absolutely happy to refer you to their friends. Animal owners, pet parents, talk to pet parents. But you have to make it easy. They're not going to automatically say, "Oh, you need to go see Dr. John." No. The doctor has to, and the team, not just the doctor, but the team, all have to play a role in creating that environment and encouraging that patient to do the recommendations and referrals. When all those things are in play, that is a marketing system.

It's not luck. And the good news is, it's all fixable problems. Once those systems are in place, once you have all of your team members on board, you have them creating an easy environment for referrals. Right. Reactivating, all that, you have a practice that is going to be highly profitable. I know I'm almost out of time, so I will stop there. You're good, Lila, and- Don, I'd like to- Go ahead ... jump in here. One practical thing that any vet could do or any hospital manager could do on this call is called a customer journey map. Yes. And, essentially, Lila kind of mentioned it, but the tracking the entire journey from when they would Google you all the way to when you would re-engage. And I'm talking about not just think about it, like fill out a little form, but actually become a client. A lot of times we think customer service is what we should be doing every day, just be nice to people.

And really what we should have what's called customer empathy. How can we be like the client and think like them? And how do we do that? Well, what is it like when they go to Google, right? And they Google your website. What does it look like on the landing page? What does it look like to book an appointment? Do I need to log in? Do I have to request? How many steps does it take for me to even just get an appointment? When I walk in the door, what does it look like? What does it smell like? What do I sound like? Does it smell like bleach? Is there cool music going on? Is it calming? Do I have to run a gauntlet in the lobby just to get to my appointment?

And then when I get in the exam room, how long do I have to wait? What's the chair feel like? Does someone sit in a chair for 30 minutes and even know, or do we just throw them on a park bench, and make them wait for half an hour, and then expect them to say yes when we make a recommendation for medical care when they're really trying to get out the door because they're a mom with a stroller? And we just didn't think like them because we're too busy in the weeds. Any sort of job that is technical, you start thinking about the technical side of it. Why do most exam rooms in a veterinary clinic have two doors? Hmm. Anyone wonder why there's two doors?

One for the client to walk through, one for the vet to walk to. The reason why there's two doors is the veterinarian doesn't want to go and be seen in the lobby. Yeah. That's why. And what's crazy about it is that they're there to see you. That is like you're giving them a-- So we've created this thing where we insulate ourselves in the back, and we actually only think about what it's like for me using the thing, and we forget what it is for a client experiencing the services that we're providing. So Dr. John, in your practice, is there only one door? There is. But it's also because two doors is a bad return on investment on income-producing square footage.

Because you have to have a hallway to service the doors. And so you generally give up at least one exam room, which one exam room generates $700,000 to $800,000 in potential revenue. So just having two doors will typically cost an owner a couple hundred thousand dollars in potential profit, and potentially millions in missed equity if they ever decide to exit. So it's a yes and. I like it for the philosophical angle of it, but you could also make a business case for it. That's amazing. Thank you so much for that insight there, Dr. John. That's one thing I've never heard on the podcast, the impact of a door, when it comes to the financial side of things.

Yeah. Conference rooms, everyone's got their own door. There's a lot of things that you could talk about income-producing square footage when you're designing a veterinary hospital. But again, if I'm just thinking about creature comforts in myself and not my clients, then I end up getting a large back, and I forget what it's like to experience the person that's paying their money to be there to provide that service. And that's the important point there, the customer journey map, of course. Really appreciate that outlook there, Dr. John. And yeah, cannot be understated, the customer journey map, as Lila also mentioned. You really got to think from the perspective of your clients and yeah.

We're always talking about empathy here, but how does that look like from their perspective? How does the journey feel like from their perspective is also important. Now, Shannon, a practice that's fully booked but financially tight, what are the first two or three numbers that you are asking to see, and what story do those numbers usually tell you? Yeah. Dr. Yonker talked about it a little bit earlier. Definitely your cost of goods is going to be the first place I'm going to go and look. Your employee total costs are going to be your second place. Your revenue growth year over year is going to probably be my third. And then more importantly, and what correlates to your revenue growth is your profitability. Is your profitability at least staying stable to your revenue growth as a percentage, or are you seeing shrinkage in that ability to have profit growth as well as revenue growth, or at least profit stability? So those are probably the biggest places that I would start looking. From those, that's going to drive me down a couple of different avenues. Do I think they have too much stock on hand?

I will tell youI used to say that your cogs being out of whack is generally an overstock issue. I am finding in the last few years that a lot of cost of goods sold being out of whack against percentage benchmarks is because we don't have our pricing right. Mm. If I produce a million dollars in a calendar year and I want my cost of goods at 22%, I need to keep it at that level. But if I can produce $1.2 million a year, I can keep my stock at the same amount, but my percent of revenue is going to drop. So what I have found of late is this fear and anxiety that doctors are feeling, and they're either discounting because of emotional reasons, they're having incomplete service acceptance, which might be helping to drive up our cost of goods. Mischarges will drive up your cost of goods.

You have the same level of product, but we're not getting the revenue that we need to from those products. So those are all big facets. So I would say that 9 times out of 10, the hospitals that come to me, they're sitting in the 30, 35% realm cost of goods to revenue. And when I say to them, "Your cost of goods is out of whack," they say, "But I run out of stuff all the time. I don't have too much stock on hand." It's funny because everybody has used the word curiosity. That's when my curiosity peaks. Seek to understand. So then I'm asking the questions of do you have a discounting issue with your doctors? Do you have a communication issue with your team being able to make recommendations and get acceptance?

Mm. Those are generally going to cause imbalance within your cost of goods, within your employee costs as they relate to your percent of revenues. So those four big numbers that Dr. Yonker had spoke to, those are definitely the four that I'm looking at. But where I go is driven by conversations when we start talking about what is your acceptance level, what is your compliance percentage? Right? Going back to everything that Lila said, even Dr. Yonker, if we're making treatment plan recommendations and we're not calling back ones that are not booked that day within a 72-hour window, we're missing a huge opportunity for client acceptance. None of us wants to get hit with a couple thousand dollar treatment plan, right? We need time to go process it, look up some information, maybe ask some friends about it. If we as a hospital don't follow up, that is potential lost revenue.

They may be going someplace else. But maybe all they need is somebody to call up and say, "Hey, do you have questions about our recommendations? I know that was unexpected. Do you have any questions? Can I help you with anything? Can I get you some resources?" And then if that doesn't produce an appointment, follow up a month later. So I think the numbers that I look at is very much driven once I get those numbers by asking a lot of questions and finding out where that hospital's issues might lie. Shannon, on these callbacks, are you prioritizing certain treatments over the others? Or are- So at our hospital, we did a lot of outreach communication.

We had lists that were split between different levels of experience within the hospital. So on any given day at my practice, we would be doing anywhere between 30 and 70 callbacks. Some of those would be done by CSRs, something super simple. Some would be done by assistants, others would be done by credentialed technicians, and then there would be another phase that would be done by the doctors. So it kind of depends on what you're calling back for and what the recommendations were, who made the recommendation. I don't want to have somebody call back who didn't understand the recommendation made by the doctor. Right? Okay. So if I'm giving a dentistry treatment plan that's a couple thousand dollars, there's going to be a lot of extractions.

I'm not going to have a CSR make that phone call because they may not understand what goes into that procedure. They may not be able to add value to it by talking through the fact that we're going to support that animal on IV fluids and there's somebody at the bedside taking vitals every three to five minutes. They're not going to know to have that con-- Well, most of them should, but they may not know to have that conversation. So my recommendation is your callbacks and especially those compliance callbacks are made based on the experience of the person making the call. Check. Really appreciate that- Mm-hmm ... clarity. And I really like the example you gave with the cost of goods.

But they might be running out and- Yeah ... the problem might not be the cost of goods. It might be you're just not generating enough revenue. Or you're discounting or leaving invoice items off. All the time, every day I talk to hospitals where part of what we run is their numbers, and I will know that they've done 250 ear cytologies in a calendar year, but they only charged for 27 ear cleanings. Mm. I've been a credentialed technician my entire career. Red flags are going off. Why are you only cleaning 27 sets of ears when you did 200 plus ear cytologies? And I will ask the question, "So did you really only do 27?" "Oh, no, we do two to five a week."

"Okay, we're not charging for those." And I will tell you, doing what I do with data-driven pricing and ear cleaning with two people, your breakeven's are about $35. So if you missed 100 of those, do the math. Right? Mm-hmm. So sometimes it's just making sure that we're charging for the things that we're doing and not letting the guilt get in the way. Shannon, just the other week, this was in a completely different vertical, dental, but I think it was such a great point where we were talking about a very similar point with regards to discounting. Now, especially veterinarians, since we're a bit of a more empathetic- Mm-hmm ... sort of peopleI'm just wondering, what do you think about this idea of having a discount fund?

Right? So upfront you have a budget. This is how much I'm going to discount, say $2,000 per quarter. Mm-hmm. Yeah. Might be a lower end. Yeah. Yeah. No, I get where you're going with that. I actually, in my practice we tracked every discount. I said, "I understand you want a discount. As a doctor, I get it. There's times you want to do something at no charge." Mm-hmm. I need to be able to track it as a practice manager. I need to be able to have an ability to see, is one doctor discounting more than the other five? Something that you should be tracking. We actually got to the point where we actually gave our doctors X amount of money every year that they were allowed to use their own judgment on to discount. If they went over that, then we were having conversations. Right? There was always conversations.

But because we had checks and balances within our pricing and our invoicing, there was always more than one person involved in the invoice. We were able to- Yeah ... talk each other down. Like if somebody wanted to discount, the other one would say, "Hey, is that something you really need to discount on this particular one? Maybe we save that for a critical case," or something along those lines. Yeah. There we go. So it's not discounting that is the problem, it's not tracking it accurately that's the problem. Yeah. Dr. Yonker, again, I'm going to harken back to what you said. You have to know your numbers. And one of the things that I think is so missing in our industry is practice owners are veterinarians who happen to be a business owner.

We have to start flipping that script to a certain degree. If you're going to own a business you have to at least-- You don't have to go get your MBA, but you at least have to start thinking like, "I'm a CEO that happens to be a veterinarian." Most successful practices find the happy medium between those two things. Check. No, Dr. Yonker? Discounting- Go ahead ... discounting is like the cigarette smoking for veterinary business. It's pleasurable, addictive, and it will absolutely ruin your profitability. Oof. So use sparingly. Everything in moderation. Oh my gosh, I've never heard that analogy and I love it and I will have to steal that, so thank you.

You can steal it. I think we're all going to kind of have that in the back of our minds any time this word discount comes in. Wow. Thank you very much, Dr. Yonker, for that. Wow. Now you scaled from a startup to two locations, 18,000 patients, 11 veterinarians. What are the decision-making traps owners fall into when they get too busy to think strategically, right? The ones you've personally walked into. We'd love to hear some of those. Yeah. I think Lila had mentioned some of this about seeing another patient is just the best thing I could do right now. The old adage of when you're working in your business, you're not working on your business. In being a veterinarian first, you think that, okay, the highest utility for me in this hour of time is for me to see a couple patients.

But the problem is managing people inside of a veterinary practice when you're seeing patients, you're not doing that. And we typically see people start to plateau around, it's in the mid $2 million realm. And the reason is the owner is often the bottleneck because they are typically the highest producer. They're the main breadwinner. And then what ends up happening is that they have what I call leadership via vibes. So they just go in and they're a nice person, and they treat everyone kindly, and they think that's all it's going to take for culture to be a positive environment for people to grow and thrive. And then they realize that the more they scale, the further they are disconnected from the other employees in the hospital, and also every invoice that starts coming through as they start to scale.

And they realize that you can aspire to be a good boss, you can be hopeful to be a good boss, but you actually just fall to the systems that you have in place in your practice. That is around financial systems, like I had mentioned earlier. All you got to do is track four things mainly every month. And then also you need time and space to take care of your people. And a lot of that is actually just do it. And what do I mean by just do it? Actually having one-on-ones with your staff. Now, Ronald went in depth about how you would do those type of things and the way that you would do them, super important. But most people, most veterinarians in the US only talk to their boss in two scenarios, if it's not just side to side in the clinic floor. And people misconstrue working alongside of their coworkers as talking to them or having any sort of one-on-one. They think that's like they're connecting with them, which is absolutely wrong.

You need a time and a space to be alone with someone, for them to share your feelings, and you can't do that on one trip. You actually have to build trust over time. It's like a piggy bank. You have to- For sure ... put little deposits of trust as a leader over time so that they would be willing to be vulnerable and actually share how they really feel, so then you can make positive change in their world. And so for most people, that's just begin by actually carving out time and space to having a one-on-one. I call them how you doing meetings, and they're like 10 or 15 minutes that happens once a month, and that everyone in the practice has that with their direct reportAnd then also, that one-on-one is leading to what our annual review, where we're making goals, so that I come to work and it's not just a rinse and repeat.

We're actually working towards something. And then we actually have a staff meeting that pushes the clinic forward. One of the sayings, "If you have no agenda, me no attend-a." So if we don't have a meeting that has an agenda that's actually pushing the clinic forward to success, what are we even doing? Or why don't we stop seeing a next patient and actually meet and improve, in terms of a practice. And by improve, I'm talking about operationally, but also hearkening back to our core values and our mission by actually telling stories. So people talk about, they throw out corporate things like mission and core values, and that lives in a notebook somewhere, and they feel good about themselves that they did it.

But really, your core, your mission, and the values you want to live out in your organization are the actual, real-life stories of how they delivered care to the clients and the patients inside of your practice. And you need time and space to celebrate in public, to reinforce those behaviors that you want to have, but then also have the one-on-one where you earned the right to criticize them in private because you cause those trust deposits over time. So, it's generally just do it, because most people actually don't have one-on-ones. They actually don't have a staff meeting that pushes the ball forward. And they're really simple things that give most of the ROI. Most people think they really need to do the self-work in leadership, and they absolutely do.

But it's after you just do the thing, just build the system first and then do the self-work after you build the system. Most people don't actually have the systems in place at all. There we go. And before I let you go, how does that 10 to 15 meeting, just a check-in, what's the conversation like? What are you asking? How are you doing? Yeah, I call them how you doing meetings because that's the first question. And at first, it's a lot of silence because the first couple of meetings, they're not going to be vulnerable with you because, A, you may have created a culture where they only talk to you in your office when they're in trouble. So why would they share anything with you? They're not.

And so it's going to take multiple touchpoints for you to earn the right to have that. Then you're going to talk about the past month. What are some wins? What are some successes that you saw? Did you see any wins or successes in your coworkers? Mm-hmm. Can you share some stories about how they did well? What are we doing on the goal-setting we had a couple of months back in January? How is that going? What have we done since our last meeting for you to improve something in your technical realm and also in your personal life? What can I do to help support you in those goals that we set together? And then the very last question, then I end every single one-on-one is, what is one thing I can do to make your job better?

And then- Mm ... be quiet. And even if they say nothing, the fact that you offered that to them is the trust deposit that happens next time. And now they might ask for something you can't do, but at least if you're willing to open to hear what they have to say, then you can help them understand, and you guys have a relationship built in trust that they can help understand why or why not. But most of them are really simple stuff. Like in the practice management software, there's this annoying little thing, and you're like, "Yeah, I could fix that." And then in the lack of communication, people make up stories. So if I never have communications with my boss, then I actually assume that they're out to get me or they're just in it for the money or fill-in-the-blank thing, but it's actually you do feel appreciation, you do love your staff, you do have this, but you're trying to do it via vibes, and you have no systems.

There we go. Let's change that leadership via vibes to leadership via systems. Really appreciate that, Dr. Yonker. That's what we all want to feel like. Appreciated, just heard. That's it. Maybe a Porsche might not be that bad either, but that's not always possible. Not immediately, at least. Now, Ronald, let's talk about masking. Masking is a word that a lot of practice owners haven't heard before. What does it actually look like on the floor of a busy clinic, and how is it costing practices people that don't realize they're losing? Ronald? Yeah, I'm not able to hear Ronald. Is it just me? Oh, okay. So Ronald, we are not able to hear you for some odd reason.

Hello? There we go. Okay. Sorry, my mic turned off in the middle of this. I don't know what happened. No, the insidious part of masking is it does its job really well, which means you're never going to notice. That's the whole point. Somebody puts on a mask to show you that they're fine, to show you that they fit into, quote-unquote, "normal," or what society expects. You don't know. And the sad part is sometimes they don't know that they're masking, right? All they know is that they get home at the end of the day, and they're completely exhausted. They have no work-life balance, and yet they're only working 40 hours a week. It's because when they get home, all they have time to do is sleep or sit down on the couch and dissociate because that's all you have the cognitive load left or the energy left to actually do. I can tell you from my own self, I speak at conferences. This is the best overlap that I can give you.

And I can be on, and I can be talking, and I can be loving it and be surrounded by hundreds of people and not think about the crowds that I actually can't stand. And then when I get home, I am not able to get off the couch or my bed for three days, right?Doing self-care, like waking up and brushing my teeth, is absolutely excruciatingly hard. And I know that sounds awful, but that's what our team goes through. So I start to think about that when we've got the person out on Monday every single time, right? It's like the person's calling out Monday and we're like, "Oh, they were partying too hard." Well, and maybe there's some truth to that, but what are they also holding all week or during the weekend when they're working at your clinic? How much are they holding onto?

And that's the mask, right? So it is looking like everything is fine. Think about how many times you said, "Hey, how are you today?" And the immediate response is, "I'm fine." And all of us are holding something. And so the mask says, for me, if I want to self-regulate my nervous system, normally I would stim in ways that's really annoying for people, and that's a repetitive behavior that calms my nervous system. And so sometimes that's pen clicking, sometimes that's chewing my pen. Sometimes there's people that hand flap. There's people that have verbal stims, like they'll hum or they'll-- My youngest son makes this God-awful, obnoxious sound, and I call it the clash of neurodivergence in my house.

But he makes this God-awful sound, and I have to walk away from it. So it's annoying to the people around us, and when you've gotten negative feedback your entire life, you try to hide those things. So I can tell you the scars I have inside my cheeks from constantly biting them all through high school was to calm my nervous system, so that I wasn't showing it in a way that would annoy people around me or get negative feedback. There's stats out there that a neurodivergent child, and I want you to hear this, a neurodivergent child by the age of 10 receives 20,000 more negative or directive feedback than a non-neurodivergent child. That's by the time they're 10. So you can imagine further on into middle school, high school, or first career, it becomes insurmountable. And so the only way to avoid that negative feedback is to look like you're really good at what you're doing. You give of yourself to your clients, you're going to give of yourself to your patients, you're going to give of yourself to your colleagues, to your boss, to your direct reports, until you have nothing left and you're burned out. And unfortunately, there's even stats in the autistic community that masking leads to not only burnout, but suicide rates.

Very-- Oh, yeah. A lot of things there. Before I do move on, I want to quickly touch on what Suzanne had just sent in the chat when you were saying your previous answer there, Ronald. "Really enjoyed your segment on neurodivergence since I'm definitely neurodivergent and always interpreted as a failure or deficiency on my part." So yeah. Yeah. Unfortunately, that's what I see in all my clients, is I think this happens across outside of neurodivergence, but I also see in higher frequency and intensity in neurodivergent individuals that there's not a lot of safety internally, right? So we might have a safe external world. You might be creating psychologically safe environments in your practices.

But if their inside is not safe, they're not believing a word that you say no matter how much you show it. Yeah. Oof. These conversations, I'll be honest, man, this kind of make me a bit emotional because a lot of these things, I don't know. That's another conversation for another time. But I do see a lot of similarities in my own way of thinking with a lot of things that we do talk about. So it's very interesting. It's a pretty heavy subject. I think it gets pretty heavy because we don't have a lot of awareness or recognition or understanding on how we work with people. And I think that's what I'm here to do in the veterinary profession. And it's very appreciated. Thank you very much, Ronald.

Mary, you often talk about the hidden drivers of burnout inside a busy, profitable clinic. What are the ones that leaders almost never identify on their own, and why do they stay invisible? Yeah. So I think we talk about the workload in veterinary medicine as being one of the drivers of burnout. But I think that's taken at face value of the workload of the patients and the clients. One of the ways that I think that overload is misinterpreted is actually how we allow our high-achieving employees to step in and fill in all the gaps. I know every practice has them. I was that person in my practice. They pick up all the shifts. They skip their lunch. They stay late.

And that piece of it, I hate to say, I think is normalized and continues in veterinary medicine because we need the help. But that's definitely one of the big ones. I think another one is that lack of control. The obvious is lack of control of the schedule. We don't know what's coming through the door. But the less obvious is when we don't have clear leadership, as John said, leading by vibes. We're not utilizing our team, but we give them a job description, but then don't allow them to do the job. Yeah. Or other challenges with the processes and protocols in the clinic not being clear. And that impacts our feeling of comfort and in control of our day, and that can create burnoutI think there's so many hidden drivers, but ultimately, one of the bigger ones that I've seen over and over again is we, in veterinary medicine, very often promote people into management and leadership because they're really good at their job.

And we forget that we need to give them role clarity and training, and then sometimes additional time and resources to be successful in that role. And it could be as simple as asking a technician to take on inventory. Sometimes it's not as far as moving them into management, but when we haven't provided them with role clarity and resources, that can also drive them into burnout because they feel a lack of recognition, and they're not being poured into. And then that comes full circle back to, how are we pouring back into the team that they are now responsible for leading? So I think all of these things, again, are normalized because in veterinary medicine, when a technician is really dedicated, that's celebrated.

And when the front desk has to take that difficult client call, the way that we typically look at it is, "Well, that's just the way Mrs. Smith is." But the more we allow the difficult clients to just be difficult because that's who they are, and not show the recognition to our team, and not make sure that our team is taking their PTO without feeling guilty or taking their lunch breaks- Mm-hmm ... the more we're going to continue to sit in this cycle of burnout. And the definition of burnout from the World Health Organization is a syndrome caused by chronic workplace stress that has not been successfully managed. And it sits at the intersection of people and organizations. It has intentionally been labeled as an occupational phenomenon and not a medical illness for that reason, because it is connected to both parties.

So there's a shared responsibility and knowledge needed on both sides. Check. Now, this seems like a lot of work for especially the busy owner, the very busy veterinarian. What kind of mindset shift are we looking at over here? Because could the owner actually get burned out by thinking about all of these things? How am I going to do all this? High performance team member I can trust on. Now, I can't rely on them to pick up whatever gaps there are, or role clarity. I want to promote Mary. I want to keep promoting Mary, but then now I have to start thinking about if I do promote Mary, I have to give a whole growth roadmap. Isn't this a bit too much on our owner?

Yeah. I think burnout, I hate to say it, I feel like burnout's kind of become a bad word. I feel like people are kind of tired of hearing it. But you have to go back to the basics. I think we've drifted away from keeping things simple, and I'm not quite sure why. I go to all these conferences, and I hear what everybody's talking about what clinics should be doing right now, and it's always at the root the same thing. And we find all of these fancy, more complicated ways to do things, and we forget, you have to make your reminder calls. You have to have job descriptions. You have to meet with your team. And those are the foundational things that are going to make everything else work. And if you meet with your team, like John said, I had a practice manager that did the same thing, and I loved it.

She called them team TPRs, and it was 15 minutes once a month. But it's easy to make sure that the team has the clarity that they need in their role, and that they're not skipping out on taking their PTO, and that there aren't challenges in the clinic that aren't being addressed because you're having intentional conversations before they're all over the floor and they're talking about it there. My motto has always been, if it's not important enough to talk to me about it in the office, it's not important enough to talk to me about it on the floor. But I'm comfortable- Mm ... saying that because the team members all have a consistent space in which they're asked to talk about it.

And- Mm ... it's important that they talk about it. And now we hear the key word, what I'm understanding is that foundational. These are foundational for a CEO, like Shannon mentioned. Perhaps not a veterinarian, but a CEO of a company. All these things are foundational to ensuring that business runs smooth. John, can I add something really quick? Yes, please. I would say to answer part of your question, owners specifically, but everybody in the hospital, they need to not just work in their hospital, they need to work on their hospital. And it doesn't have to be eight hours a week. It can be, I get 30 minutes every week where I'm going to focus on working on my hospital, and maybe that's on my team, on my culture, on my writing job descriptions.

If they're not doing that, they're not carving that time out, it's never going to take the priority, because otherwise they're seeing patients that's driving revenue. And yes, that is important, but your team is also important to driving your revenue. So if you can carve out some time to work on your hospital, everybody will benefit There we go. And I'd like something you said. We always say this to the owner. The practice owner, the manager, you need to carve out some time to work on your business. But what about the rest? The team. They also need to carve out a little bit of time to work on their role. Right? That's when you can, I'm assuming you can identify, okay, I don't actually have clarity in this role.

Let me bring this up to management. Right? Otherwise, you're just feeling it, you're just getting burned out, and let's make it so that you're empowered, and you also find the solutions without always relying on someone else doing it for you. Right. Lila, let's talk a little bit about money. A lot of owners feel like they're spending on marketing without seeing a clear financial return. Right? So how should they actually be thinking about marketing ROI? Okay. The thing is, most owners look at the schedule. All right, how many new patients did I get? That is their number one thing, and that is an important number, but the thing they need to focus on is the revenue. How much did each of those new patients bring now? So let's have a hypothetical.

An office has a $5,000 a month budget, and that $5,000 is bringing them, say, 42 patients. $125 a new patient, that's good, but what are those 40 new patients actually bringing into the practice? If they're just coming in, getting a simple nail trim, and they never see them again, that office is going to barely be breaking even on their marketing budget because by the time you're looking at they've spent a couple of hundred dollars on that appointment, now there is a doctor's cost, the overhead of the practice, all of these consumables, and so they are spinning their wheels. Now, let's flip that script. You have your plan, you're looking at all the details.

Same 40 patients, same $5,000 budget. But now we're looking at what's going on, and you have the systems in place. You have your roadmap, you have the follow-up calls coming in to those patients, and so they're sticking around. Now, that couple hundred dollar patient is now bringing in, over a couple of years, $2,000 plus. Now your marketing is actually paying for itself, and you are generating revenue, you're generating new patients, your team is doing everything they're supposed to, and those new patients are actually generating new patients of their own through referrals. So that is when the financial outcome changes by tracking it. We've talked about numbers a lot.

It all comes down to mapping and numbers. But you've also got to have a solid marketing plan. I talked about earlier just having a SEO plan here, a AdWords campaign there. You need a comprehensive plan that's going to be bringing you the right patients in. And to do that, that's where somebody like Ekwa comes into play. Mm-hmm. We create those marketing plans for our clients. We work with you to find out what you're looking to achieve. I'm working right now with an office. They are very niche. They're focused on primarily dogs, and they are a fear-free office. And so they- Mm ... have a very targeted plan. Actually, I'm also working on the other side of the aisle with an office that focuses on cats.

So we're equal opportunity, especially like in my house, we are cat and dog friendly. But both of those offices are very unique and very niche. Now most of our clients, they work with everybody, from pocket pets to some of them do exotics. But we create the plan around what our clients are looking for, and we'll find that. What a meeting with me looks like. We come in, we'll spend about an hour together. Our team will spend quite a bit of time getting to know your practice. They're looking at your reviews. They're looking at your online presence. They're finding out where your strengths are, where your weaknesses are, and it's either me or my colleague, and we're going to sit down, have a very productive hour.

What is our goal for this hour? We want you to come out of that meeting with us knowing a lot more about your marketing than when you came in. You're going to understand what your strengths are, what your weaknesses are. Where are you losing your patients? For example, an office I was talking to earlier this week, it took me almost three minutes to find their phone number. Is that good marketing? No. How many patients are they looking? Book now button there, but yeah, if somebody needs to call to find out, "Can you do this? Do you have an appointment available sooner?" They're going to be onto the competition. So that's what we're looking at, is where your weaknesses are, where your strengths are, and we will create a custom plan around that. And there is absolutely no commitment. All we want is an hour of your time, and bring a cup of tea, bring a pen, because you're going to learn a lot in that meeting. I could talk about all of this for a very long time. It's my job. It's my passion.

Especially veterinary. I'm a certified animal nut. I have to admit that. And if you book with me, my cat might even make a guest appearance. Amazing. It cannot be a meeting in veterinary if we don't have a cameo by one of our wonderful pets. Well, this has been a bit of a first one, today actually, where we didn't have a cameo, but that is what it is. So go ahead and grab your spot with Lila. Here's your cameo. Oh, there we go. There we go. She's 20 years old. Her name is Cookie God bless her. Aw, that's amazing. So, go ahead and book your meeting with Lila. It'll be time well spent. Get to know where you're at in your marketing. And of course, the way I really like to think about this is you're risking an hour. Well, you see Lila over here, but really, what you're investing is an hour of your time. There's no obligation whatsoever.

But if you don't, well, it's another year of your competitors showing up when treatments that you offer are being searched for by your ideal patients. So, go ahead and get that clarity on the way. And with that being said, the link is in the chat box below, so you can find it there. Or else you can go ahead and scan that QR code on your screen to book your meeting. It'll take less than a minute to do so. Right. Now, let's get into perhaps one of my favorite parts of the evening, your Q&A. So, this is where we are going to answer some of your question and answers that you might be having. I think you can go ahead and drop them into the chat or the Q&A, and we'll answer them along that. And I know we had a couple from our registrants here that I'm going to pull up and answer while the chat gets a bit warmed up.

Here we go. So let's see. As well as I pulled out some from our community as well just to answer here. So this is kind of a free-for-all, so anyone feel free to join in and answer these questions, because that's what our community deserves, answers. Let's see something we can... I feel like... Okay. Here we go. This one is an interesting one. Ooh, okay. We got Karissa, a practice manager, asking: How can practice owners and managers be aligned for success? Hmm. Mary, would you like to start? Sure. So I would say first and foremost, are there goals established for the clinic for the year? And once there are goals for the clinic, the owner and the manager should be meeting at a cadence that's appropriate for them.

I prefer weekly, to sit down and talk about a certain agenda, both short-term and long-term, to make sure that we're moving the needle on what needs to happen now, today. Staffing issues, hiring plans, things of that nature, but also that things are staying in motion to accomplish the goals by the end of the year, so that we don't come up on December and the strategic planning we did in January was only an activity that we did in January. So, I would say those weekly meetings are incredibly important, and having a structured agenda that is the same every week with your really important non-negotiable topics is what the practices that I've worked with have found most helpful.

Hmm. Yeah. I'll ditto that. I'm a huge fan of the EOS, the Entrepreneurial Operating System, and running level 10 meetings where you've got metrics that you're reporting out every single week that are leading metrics and not lagging metrics, that you are reporting on where you're at with your quarterly goals and having accountability for your weekly tasks, and then making sure that everything is in alignment with the annual goals that you've set forth in the annual planning and strategic planning process. Check. Now, this question was repeated twice, right? So I'm actually also curious from Dr. Yonker's standpoint, what do you think about it? And how would you actually go through a meeting?

What's the agenda there? Important for owners not to completely abdicate their financial responsibility to their practice manager, that they should be part of the discussion. A lot of the performance happens because they're completely in the dark, or maybe neither one of them has the right info because they don't have any of the accounting systems to be able to report, like I was saying previously. There's an old adage, "Show me the incentive, and I'll show you the outcome." What is the incentive of the person to help you? Are they a part of the team? I like to simplify things. You probably heard me simplifying things into one or two phrases. If I have too many things, I got to do this, I got to do this, I got to do this, it makes things quite hard for me as a manager because I'm also kind of seeing patients. And so having small repeated touch points over time, like daily, with my practice management, if I'm in the office, kind of at the end of the day, like what happened today, a little pass off at the end of the day. A huddle in the morning with the staff. These little small rhythms stop you from having big lifts later. That's the key thing is people just forget that regular rhythms are probably the easiest thing that they can build into their practice that helps take a lot of mental bandwidth off of them because it's just these things. I don't have to schedule a meeting.

I know that this 15-minute check-in is going to happen without me having to do it myself. It just happens at this time. And so, automating as much as you possibly can takes the mental bandwidth off of everyone. And then when you're there, you have a structured time of what you're going to do, and then you push the ball forward. There we go. Thank you very much, Dr. Yonker One last thing I would say is the meetings never get canceled unless you're on vacation or you're sick. There should be no other reasons those meetings are pushed, period. Check. So I think there were Carissa and Connor. We hope that your questions were answered there. And let's see what we got here. We got, okay.

Oh, we actually had a question here in the chat, by Melanie. Melanie is asking, "Simple formulas for determining break-even point for pricing services." Shannon, can you start us off with this one? Yeah. I was looking at that in the chat. Simple formula, there really isn't one. But what you have to take into consideration is you're not just taking your team's hourly and dividing it by 60 minutes to figure out a billable price per minute. You do need to know that to a certain degree, but you also have to take into account that you've got non-billable labor, your CSRs, your managers that are going into time allocations. You have to consider all of the consumables that go into your services.

You have to consider an ROI on the big equipment pieces that we're using during each of our major services. So a simple formula, not a great answer. I have the luxury of having a patented piece of software that does most of this math for me. Once I plug in a hospital's profit and loss statement, plug in their total compensation for all of their team members, billable and non-billable. There's not a good simple one. That's been the problem within our industry. We have historically set prices by, I think Dr. Yonker said it, by gut or by feeling, or benchmarks that are generally outdated by one to three years, depending on how often they are being printed and, or presented at this point.

Now we're no longer printing those kinds of things. But that's how old I am. Or our competition. So there isn't a great simple formula for it, but you can start kind of getting to the basics of am I considering at least some of my consumables, my ROI on my equipment, my team costs, who's doing what. That's when you get into the nitty-gritty of is the right person in the right role doing the right job. Because it costs more for a doctor to perform a nail trim than it does for a technician or an assistant. So some of this comes down to do you have the right people in the right roles doing the right jobs for the right amount of time? What does it do to profitability if it takes four people to do a nail trim because we have a difficult pet and we've chosen not to use some sort of sedation, or what does that do to our nail trim? If we're start charging the same $25 nail trim, we have four people fighting with a pet for 10 minutes, we're not just losing money, we're losing an excessive amount of money.

So I noticed Dr. Yonker put a link in there, so that might be- Yeah ... a helpful piece too for some of the simple parts. There we go. Appreciate that, Shannon. It's honest, right? It's not simple, but it's honest and definitely Dr. Yonker has... Would you like to say a few words there, Dr. Yonker? Yeah. Shannon and I have never met before, but I think we'd be great friends because I think we think very similarly. Yeah. You can figure out your prices by working backwards from your expenses. But it can be difficult to do that when you have associates that get paid on production, and it ends up kind of being this circular mathematical function, which is way more than what we need to be thinking about today. But the point I want to leave you is it's not about just breaking even because we've got to make a profit.

And so, there is a general break-even point that you can figure out for your entire practice by doing some math. But there's a 48-minute-long episode on how to figure it out because it takes 48 minutes for me to walk you through how that would even-- I can't give you a 30-second blurb on how to do it. Right. What most people do is that they copy another clinic down the street. But in a sense, when you copy their prices, you are also copying their expenses. You have no idea if they're profitable or not. You have no idea if their building is paid for and they don't pay any rent. You have no idea about those things that affect their underlying profitability, and it could be quite risky- Mm ... to just call around. However, you do have to call around because the market sets one price. There's certain things- Sure ... you can't just indiscriminately jack up a price of your exam or a rabies vaccine in a vacuum.

And so the market ultimately sets the price. However, your prices need to be set with some sort of mathematical rationality. Goods are very easy to figure out. I know my wholesale cost. There's a markup applied to that, standard markup. You can look that up anywhere. And then services are where it gets tricky. If I just look at- Mm ... my labor, I forget about this parking meter that is everything else. So my rent gets paid monthly, so in a way it's charging me per second to be there. My insurance is also being paid monthly. You could break that down into seconds or minutes. And so it's not just the labor that you're paying as a function of time, actually all of your expenses are paid as a function of time. And so when Shannon does activity-based costing, so you look at an activity and see how long it takes, they know what it is on a per minute basis. You can use my math to kind of work yourself backwards to do it and hopefully, you can do that.

But you can also pay for a company to do that as well. But it's tricky. However, you have to look at it that you can't do this in a complete vacuum. And again, your profitability is a function of revenues and expenses. You can't just use Shannon's tool, jack up all your price. Not that she was going to do that, but you can't just indiscriminately just jack up all your prices and then don't look at your expenses and then be profitable. It has to be "yes, and." Yes, I'm going to be thoughtful and considered on what I charge, but I'm also going to watch how I spend.Because revenues minus expenses equals profit. There we go. Amazing answers here, Dr. Yonker. Thank you very much.

Now, Jeff has asked a wonderful question in the Q&A box here. Many owners are driven by their clinical ego. That's why they went to school. Okay. That's why they went to school. Is this why many owners are monster producers? And then what and when should they refocus on their intentions? And then last question, this is the one that excites me the most, how does this transition happen? I would love for Mary to take a lead on this and then perhaps even get everyone else's ideas on this. Oh, gosh. Also, I'll take a shot at it. I'd love John's opinion on this too. So I think that the reason that owners are monster producers, I think he said, they're owners.

Yeah. Right? They've got the skin in the game. They've got the rent to pay. There's just a whole different perspective, I think. So at least personally, a lot of the owners that I've worked with, it's the biggest driver. Honestly enough, it's really hard to work with them to get them to understand that their job should actually be to take their ability to produce like that and teach all of their other doctors to produce like that. And when you can do that, I think that's when the best shift happens. So I think that answers the question, but that's what I've experienced. Okay. Go ahead, Ronald. I saw you wanted to chime in. Oh, I was just going to say, try having the payroll bill be on you. Like as a previous partial owner with another veterinarian, when I was responsible for a $100,000 payroll every other week, because we had six locations overall, two pet retail stores, and a pet resort, as well as three animal hospitals.

When I had a $100,000 payroll bill, you want to produce. There's kind of a drive to produce more and to do better medicine for your whole business, and the responsibility of the people that you've employed. There's so much heart that goes into making sure that your people have a house to live in, to make sure they have food on the table. I just really cared about the people I employed and felt really responsible for them. Go ahead, Dr. Yonker. Yeah. So, I was a million-dollar producer. I produced over a million as an associate. When I was an owner, I did 1.4, and that doesn't matter. I can do those things, but it's actually not the most useful time seeing patients. The hardest thing is for people to make the transition from DVM to CEO. You'd mentioned, oh, it's not everyone to be a CEO. Well, if you're a veterinarian owner, you do have to make, at some level, that transition from DVM to CEO.

There's a classic principle, the Peter principle, essentially you get promoted to your level of incompetence. And so you go out there and you're like this amazing-- You don't have to be a million-dollar producer to be an owner, but you're a high-functioning associate that's producing. You're getting all this great positive feedback and you're seeing someone else profit. Generally, the production check you get as an associate, your owner is making that in profit if they have a well-managed practice. And so you see the opportunity for yourself, "Oh, wow. I could actually make my production check and another 20% on that money." And so there's this financial incentive to go out and do it yourself, and then you get out in the real world and you get punched in the face because this whole entrepreneurial thing is not easy.

And it is the hardest thing you'll ever do, being an entrepreneur. It's one of the most satisfying things for me in terms of in my professional life, and so there's this double-edged sword. It's kind of like parenthood in a way. It's like this something you love so deeply, but it also takes so much from you. And so entrepreneurship is kind of like the professional version of that. One negative review, then you can't sleep at night because you care so deeply about what you're doing. And so your business is only as good as when you're not there, not when you're there. So cool, you're generating all this revenue and all this profit, but it's all on you. And so actually, your business is really just you and your sweat equity. It actually has no real value to anyone else, economic value to really anyone else.

It may be generating some sort of cash flow, but you didn't become an owner to basically just be chained to your business. You became an owner to have financial freedom, personal freedom, to go drop off your kids at school and pick them up in the carpool lane that afternoon. That's actually probably why you wanted to be an owner, those type of things, and you actually have to work yourself out of a job. Mm-hmm. And so the first couple years, you're gritty, you're trying to get people to like you, and just like, "Like me, this is my business. Like me." And then you're producing over a million, and then your employees are starting to get frustrated because you're just seeing so many patients. And then you're like- Mm ... duct taped everything together and you're doing that leadership via vibes that we talked about. And then you get another associate and you're like, "No, like them." And then all your clients are like, "No, we want you, Dr. Yonker.

We want you." And you're like, "No, you need to like this associate." And then you start slowly over time replacing yourself and making that transition from DVM to CEO because now you have time and space to think strategically instead of seeing the next patient. And that's why most clinics in the United States are stuck in the plateau- Mm-hmm ... because the owner can't make that transition from DVM to CEO. Appreciate that wonderful outlook there, Dr. Yonker. Ronald, there is a question regarding how does understanding of culture individuals in the practice and the use of targets with rewards impact the culture, dot, dot, dot. And- What was the question?

How does understanding of culture individuals in the practice and the use of targets with rewards impact the culture? So this is by a founder. Rewards. I guess it depends on what you consider what a reward is, right? Are we talking- This has been- That was weird. It just depends on what you consider a reward is. I think if you reward everything, you've now created an entire culture that everything needs a reward, right? Mm-hmm. And so now all of a sudden you're trying to ask a team to do something, they're like, "Well, what do I get out of it?" And so I think sometimes I don't like to do a monetary reward or a physical reward every single time. It's like, I want to know what my team cares about. I really want to know what they care about, and can I give them more of what they care about?

Sometimes that's just servicing the patients. Sometimes that's more time off. Sometimes that's something you're completely surprised about. So it doesn't always have to have a monetary value. Check. So have a conversation with your team, get to know- Yeah ... what they're interested in, and then help them align accordingly. Right. Now we have arrived at the end of the session here, almost. I do want to get a quick... What is this? All right. Yeah. I do want to get a quick golden nugget from each one of our panelists. So let's see, what is the key takeaway if our audience members can only take away one? Mary, can you start us off? Yeah. I think for me, pour into your teams. It's your biggest expense.

And we train them to do blood draws and to talk to clients, but we don't train them how to support themselves and each other and on workplace dynamics and communication, and that interpersonal conflict is a lot of what contributes to burnout. So I think pouring into those teams, especially, some of them start at kennel assistants, it's their first job out of high school. They stay with the practice. They have to learn how to manage their emotions in practice and how to not make assumptions about their teammates and effectively communicate. Manage emotions, don't assume, and perhaps that is a way of effective communication. So- Yeah ... thanks for that reminder, Mary.

Yeah. If anybody's interested, look up cognitive distortions. There is a variety of cognitive distortions and how you can very clearly see how they show up in veterinary medicine. So that is a great starting point. Cognitive distortions? Yes. There we go. We'll definitely have a look on that. Let's see. Shannon? Yeah. I think my biggest nugget takeaway would be know your numbers. You can't just have an accountant who runs a P&L and sends it to you once a month and not look at it. You need to know what your margins are. You need to know what your percent of revenue is for your biggest ticket items, your cost of goods, your employees, your rent, your utilities. All of those make a difference.

Pennies on the dollar over time can turn into thousands of dollars, and if you wait too long and you get behind, it's really hard to make up the difference without some pretty significant changes. Going back to the question about the owners and the practice managers, that needs to be a two-way conversation. Practice managers need to know the numbers. I can't tell you how many hospital owners I work with who come to me and they say, "Well, I can't share my numbers with my practice manager." Then they're not managing your practice, right? You can't manage what you can't track. So I think for me, that's the biggest takeaway. Even if your numbers say that you're losing money, at least you know where you have a starting point, right? If that's the case and you're a no low practice or you're less than breakeven, at least you have room to go up, right?

So know your numbers. Seek to understand them. If you don't know how to read a P&L, talk to somebody who does. The other thing is know what a financial statement is, what the difference is between a balance sheet and a P&L. Again, learn to be a CEO. I can't tell you how many hospitals will do a one year P&L and they'll say, but I'll say, "This is your net profitability." And they say, "Well, I didn't have that much money in the bank." Well, it's not a balance sheet. Let's talk about what those things are. So many owners, they become owners by chance sometimes. They bought the practice they worked at, but they really never got the experience on how to run it. So know your numbers, learn how to run a practice as if it's a business.

Shannon, I really liked one point over there, which is, even if you're in red, right? That's not the end of it all, right? Because I feel like, when you're a business owner and you see that, and it might be your first time and the sheets are saying it's red, man, you're in the negative. That's okay. You don't want to be transparent with anyone because you think, "Oh my gosh." The practice manager seeing this, they're going to leave me tomorrow. No. That's when you just have to have that be honest, be transparent, have a conversation. We're going to work on this together. It might take 12 months, might take 24, but we can get those numbers up, and I have hospitals all the time that can go from negative to double digits positive in a year.

Amazing. It just takes a little bit of work. Yep. Amazing. Lila, what do you got for us? Do not undervalue the importance of marketing. And from everything, like I said, marketing includes that patient map. So first, and I'll also add this, identify who your ideal patient is. Mm-hmm. That is where your marketing starts. Who are you looking to attract? Do you want the emergencies? Are you looking to get the young pets in that are going to be with you through that sad final moment? And then create a plan around that. Create the plan in the office for those recalls, those check-ins, all of that. It's all marketing. It's all about the patient experience, the patient map. But marketing, marketing, marketing.

Figure it out, and have the right team behind you. Mm-hmm. It's not everything you can do. Part of it is going to be in-house, but part of it is working with a solid team that is going to support you and your vision and your growth. Check. Thank you very much for that, Lila. Ronald? Yeah, I was thinking hard on this one. I think if the takeaway for me, if anyone takes anything away, is that the only people who can survive your practice are the people who can override their needs indefinitely, then that's not high performance. I think that's an attrition problem waiting to happen. Okay. Very interesting takeaway there. Definitely something to think about.

Dr. Yonker, what do you got for us? Yeah. The road to success is paved with mistakes well handled. Say it again. The road to success is paved with mistakes well handled. It's very easy to get in front of a panel of experts, and it looks like they have all the answers, and that they aced the test. And really the highest order people engaged in a process of iteration and curiosity and got better when they made mistakes. You think I was operating elitely at a little tiny little startup practice in 2018? No. I was just doing the best that I possibly can with what I had at the time. And then I'd make an error, and then I would learn from it. And I would create a process around if there's anything that I was ever good at, it was learning from my mistakes.

And so where I'm at in 2026 is just someone who just made a bunch of mistakes and learned from them. And so that's really all we are. And so please don't believe the lie that you just need to get some sort of secret nugget of information- Mm-hmm ... and then all your problems will be fixed. That is not the case. It's about learning from your mistakes and getting better every single day. Love it. Thank you very much, Dr. Yonker, for that wonderful takeaway. Although, there might not be one single secret takeaway that can fix all your problems, just knowing that success comes through good iteration is a good thing to just keep in mind, especially if you're going through it.

Right. Let's begin the wrap-up sequence here. Like we mentioned, please do make the best use of EquiMarketing's complimentary marketing strategy meeting for you. If your ideal patients in your area are searching for the treatments that you are offering, be the one that they find and, of course, choose. Go ahead and book that meeting and get some clarity on your digital marketing side. QR's on the screen. Links in the chat one last time for you to go ahead and do that. With that being said, I do want to extend my heartfelt gratitude to Ronald, Shannon, Dr. Yonker, Lila, and of course, Mary, for really just being so selfless with your expertise and just giving everything out to our community here in these past two hours. And, of course, to everyone who joined us, thank you so much for investing in the success of your practice. Now, as you exit the webinar, a short feedback survey will pop up. Please do take about 30 seconds to fill it out because it'll help us keep the events coming better and better for you. With that being said, it has been my honor and pleasure to host this event on behalf of the Veterinary Business Institute. Until next time, take care, everyone.

Good night