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Jun 19, 2023 · 25 min read
Our guest in this episode is Dr. Carrie Johnson. Dr. Carrie is the Resource Optimization Manager at United Veterinary Care where she spends her time making sure her practices are being as resourceful and efficient as possible.
Dr. Carrie’s career thus far
Dr. Carrie’s Thesis: What it is and how she’s carried it into her career
What a Resource Optimization Manager even is
Plus much more
Thank you so much for listening to this episode! We hope you enjoy it!
Welcome everybody to another episode of Vet Clinic Convos. Today my guest is Dr. Carrie Johnson. How are you today?
Dr. Carrie Johnson:
I'm doing well, how’re you?
I'm doing great. It's a Friday morning, and I'm excited to be doing this. So one of the first things I always like to ask the guests is, if you don't mind getting us started with some background on who you are, how you got into the veterinary industry, and just your journey through all of that.
I would love to share that. I'm sure everyone likes to share their story as well. So I have been in the veterinary industry since I was about 15, or 16 years old, always really been drawn to animals and things like that.
So that was really the reason that I joined. And I think over the years I've learned that I came for the animals and stayed for the people, which is a different perspective than I think a lot of people.
I kind of worked my way up at a general practice from kennel tech all the way up to technician. And then from there, I moved over to like emergency medicine, and specialty medicine for a few years. And then I managed my own practice. And now I work for United Veterinary Care.
I am a resource optimization manager. So I work with, we have a group of a little over a hundred hospitals now, and I work with them for a lot of like business strategy. How do we, how do we mobilize initiatives and things like that?
Educationally, I think. My path is a little bit different than a lot of people in the field with a doctorate degree. So a lot of people are vets and I am not. So I have a doctorate in organizational leadership. I was on the path to vet school at one point. I got my bachelor's in biology and was applying to vet school, worked in a clinic while I was doing so. And just really, I think over time discovered that it wasn't for me, partially because I wasn't getting accepted. But also I think in the path of that, I realized that I wanted something different. and wanted my impact on the field to be a little bit greater and widespread.
And being able to really have really good leadership skills for people in the clinics and being able to support them differently than they currently are being supported.
I think that's a great journey. And I think that's a great reason to make the pivot that you did.
You touched on it already, but I'd love to get a little bit more, especially just from an outsider's perspective. But is there a little bit you can talk about United Veterinary Care and what makes them different as a consolidator or just as a company as a whole?
Yeah, so this is the second consolidation company or partnership company, as we like to call ourselves, that I have worked with. And I can say that it is a night and day difference between some other organizations in the sense that we truly want this to be a partnership.
So a lot of the hospitals or all of the hospitals we work with really have strong leadership at the ground level. And so we really work with them to... figure out what truly works for their practice. It's not a one size fits all. We're not mandating anything. It's really building the relationships, building the trust, and then being able to kind of make the difference.
And I think where UVC is a little bit different is they have a lot of focus within mentorship and wellness and really being able to understand and create initiatives that really make an impact for everyone within the practice. to cess.
Okay. Yeah, I mean, that's, that sounds awesome. And that's kind of the reason I wanted to ask you is I know every consolidation and partner group is kind of different. And I'm always interested in hearing the different way that they work with the practices because I think one, I feel like they get a bad rap a lot of times for bad reasons.
I really. believe in the, I mean, it reminds me, I just watched the Elvis movie not too long ago. And it's the whole thing of if you don't learn the business, the business takes advantage of you. And I feel like that's part of where the bad taste comes from with veterinary partner groups like this, just because there's not a lot of business focus in the veterinary space until I feel like very recently.
And because of that, that's why consolidators are just. popping up like crazy and they're taking over so many practices just because that's not the focus of a lot of people. But I appreciate you sharing a little bit about United.
Another thing I also wanted to talk about that's based on what you already touched on, but I think you have a very unique role. And I don't know very many people that have that specific role. And I'd love it if before you could touch on what you do in your day-to-day as resource optimization manager.
Yes. Uh, we over here are, are very big believers and just maximizing everything that you can because that's everybody has the same 24 hours in a day. So if we want to get everything we want done, we need to utilize and be as resourceful as possible. And that's why I think it's great that you have this role that that's, it sounds like all you do, but yeah, sorry, I'll turn it over to you.
No, you're fine.
Yeah, so I think one of the other things that really sets UVC apart is a pretty robust support structure for our practices.
So we're broken up by region just like every other company is. And within those regions, the hospitals have a couple of support people. So they have their main support person, we call them their operations advisor, and then they have me, which is resource optimization. and I'll get into that in a second, but we also have someone from learning and development, which really helps the staff develop.
We have someone who does client experience types of things, building with marketing, and then we have a people person, right, so their HR, dealing with those types of situations. And then we have myself, who I am probably the most analytical of everyone in the group, so I am in the numbers pretty much every day looking at P&L statements. figuring out why things may not be working the way they think we are, and being able to take that reporting back and translate it into tangible results for the practices.
Right now, we have a really big initiative on cost of goods. There are a lot of different things that go into this. Being able to take the data and pull it in to- things that the practice can do on their day-to-day. And it's not always coming from, let's increase your prices, right?
Sometimes it's, let's market ourselves a little bit differently. Let's really be more strategic about how we utilize our staff. Can we, you know, give everybody, work more efficiently really is the best way to put it.
I think on my day-to-day, no day is the same. So it's a little difficult to try to give like a general synopsis. Cause one day I could be meeting on how to do your inventory counts, which is coming up in a couple of weeks. And then the next week I could be partnering with our learning and development department to kind of create a mentorship with our practice managers or hospital leadership.
Yeah, well, I know for me, I know it sounds like you're not as thrilled, but I love having something new to do every day because it keeps me engaged.
I do, yeah, but, I'm also glad you touched on that, uh, especially cause it's something I want to get into in a little bit, but one of the things that I really think is not talked about enough in this space is that I think.
Underutilization of resources is a major factor for a lot of the burnout that is in the space, whether that's you're not utilizing your technicians to their full capacity, or I guess, ability, not capacity, or whether you're just, there are ways that you can make your life easier. Instead of whether it's certain tools or whether it's certain techniques or whether it's simply adding standard operating procedures of how you run your practice.
But we are very big believers and that's kind of what we're trying to also do is help educate of just especially with clinics that don't have business backgrounds that hey, resource utilization and resource optimization is one of the best ways to prevent burnout because you're just making your life easier. You're working smarter, not harder. So I think that's really important of what you do. And I really love hearing that UVC has not only just you as a position, but they have you working with this other team of, OK, this is your support person. We'll do whatever we can to help you out.
When you have the education person, is that just for formal continuing ed? Or is there a kind of job to just, I guess, with iron sharpens iron? Are they kind of always looking for just ways to improve and just constantly educating and then they take that and they bring it to their regional practices?
There are a lot of different things that they do.
So we have this big, you know, recover CPR initiative and trying to get all of our practices to recover certified. And then I think there are more unique initiatives, like how do we drive compliance for clients, right?
How do we get them in for their wellness appointments? And what can we do as a practice to really encourage that? And then I think general, you know, training and staff development. I know we have a partnership with the Purdue VET Tech program, which is relatively new. We have a couple of people going through that, and that's been really helpful.
The practices have already seen a kind of improvement in just general clinical knowledge and skill.
Do you mind, I’m sorry, I don't mean to interrupt, but can you take me through the Purdue technical program? I'm actually not familiar with that and what you're mentioning about that.
I am slightly removed from it, but I know it's an online vet tech program that Purdue University has.
And I know we have a couple of people, I think, throughout our network that are in it. And they have been doing really well. It is a company-sponsored event. They have to go through an application process and things like that, and then they have to apply to the school, obviously, but I think overall it's been really helpful and encouraging for a lot of our practices who really have people that want to develop themselves and want to be more of an asset to their practice.
OK. Sorry, I cut you off.
No, it's okay.
I don't know. What were we talking about before picking back up on?
We're talking about the education, the person in charge of continuing.
Yes, so they have, again, I don't think any day is the same for them.
They travel a lot and they make sure that they visit different practices. A lot of the time it's evaluating their equipment, right? Do they have the right tools to do their job? Or if they have the right tools, do they know how to use them appropriately? And just general training, right?
They're basically boots on the ground and watching the day-to-day functions of a practice How do we use our technicians appropriately? So if the doctor's in the room, can they be running blood work? Or do they know how to run the blood work? That type of stuff.
Being able to kind of create tangible results for the practices to drive revenue, of course, obviously, but also improve quality of life within the practices for the staff. If they know what they're doing, they're feeling valuable and therefore reducing burnout.
Yeah, no, that's awesome. I really like the structure. I'm not used to seeing that set up for a partner group with a bunch of practices running that way. And so you mentioned that you spend a lot of time, and you're very analytical.
So what are some of the like? key, I know you say you spend a lot of time looking at PNLs, but what are some key metrics that you look at to help, I guess, not only do what you do, but to help just drive practice growth in general?
So I think to do what I do specifically, I look a lot at where is their money going, right? And what can we be doing differently in that aspect?
So I think a lot of practices just have poor inventory management and that's probably 90% of our problems. And there's another bucket, right? Do they have a pricing problem? Maybe they are managing their inventory appropriately, but they're charging next to nothing for it.
And then lastly, I think there's kind of a bucket of a manager doesn't really understand the business mechanics behind a lot of the decisions that are made or need to be made or kind of what levers to pull if something is high.
So if your cost of goods are high, what are the things that you can do in practice to educate your staff, to educate yourself, to really reduce that, but also increase your EBITDA? So those types of things I think are pretty important.
Yeah, you touched on this, but the poor inventory management, what do you typically, do when you see somebody doing that, how does that typically look? Like, is it just as broadly as, I'm trying to figure out the way.
What would make a practice be poor at managing their inventory, I guess, is a better question.
Yeah, from what I've seen, a lot of practices have a very manual system for managing their inventory. It's kind of a drive-by type of system. We need, I don't know, antibiotics today. I'm just going to place a quick order or they just do a quick manual count every week, which I think is fine.
But I really think if we're trying to be more efficient in our just general business mechanics, but also day-to-day management, we really should work towards automating that. Right? A lot of the practice management systems now have pretty robust inventory management systems. So being able to utilize that appropriately, how do we put in our codes? Are they set up correctly? How are we charging for things? Right? I think a lot of practices have like a blanket code for a lot of different things.
And they're losing revenue for larger animals, making more on smaller animals. And we're saying, well, it all works out in the end, but we have no proof that it does. Right?
So we want to make sure that we're charging appropriately and also being able to kind of make up for losses in the sense of we're paying for these products, we're paying for our staff to get these products together for a client, we're paying for staff to administer these things and being able to pull all of those pieces together.
And then lastly, I think just general ordering, are we ordering the right things at the right time at the right price? We use Vetcov pretty really heavily actually in our organization. It has been really good as far as cost savings, really getting some good vendor contracts in place and being able to kind of work with staff of are you spending the right amount each week? And how do we know it's the right amount? Right. What is that number based off of?
Obviously, our clinics are given a budget at the beginning of the year of your cost of goods needs to be X percent of your revenue. Your labor needs to be this percent. But how do we not only meet that, but maybe exceed it, right? So that we know that we're using our resources effectively.
Yeah, that's the exact answer that I was hoping you'd provide.
Because again, I'm an outsider coming in. I kind of wanted to better understand. And I think you summed that up and what a practice should be, not only looking for, but hoping to reach as a goal for proper inventory management.
So shifting gears a little bit, I'd did a little bit of reading and saw that you did your, so your doctoral thesis on the, how mental illness compares to, and compassion fatigue are related and how you are trying to figure out solutions to intervene and solve that.
Do you mind breaking that down a little bit and kind of explaining that a little bit further and. how that possibly, I imagine, it's something that you try and do in your actual job as well.
Yeah. So if you ask a researcher about the research, they can talk for days, but I'll try to summarize for you quickly. So what I did for my dissertation was a cross-sectional, not experimental study. So I was using kind of one point in time survey techniques.
And I surveyed a population of veterinary nurses in both the US and Canada. It was about 70% US, 30% Canada. And I was using pretty well-developed. instruments of professional quality of life skill, which detects for burnout, secondary traumatic stress, which are the components of compassion fatigue, and then compassion satisfaction.
And then I kind of pulled in mental health constructs of anxiety and depression, just using kind of really well known easy scales for people to interpret as they're doing it. And then I also pulled in pieces of demographics. So where are they from? Where do they work? Those types of things.
And then I think what makes my study a little bit different is I also pulled in controls of perceived organizational support. Are they using prescription substances or alcohol inappropriately? Are they high in self-compassion? And those types of things being able to see if they're nice to themselves, do they have lower burnout and those types of things.
So what I found throughout this study was The population or the sample really that I had of these veterinary nurses or technicians, whatever you'd like to call them, had really high burnout and secondary traumatic stress, which again makes up compassion fatigue.
But they also had really high levels of compassion satisfaction. These all linked together with anxiety and depression. They were very closely linked and the relationships highly correlated with each other.
Again, we can't say that's causation. There are a lot of antecedents to all of these things. But as far as compassion satisfaction, the interesting thing in these relationships with, we'll say, burnout with anxiety and depression, and then secondary traumatic stress with anxiety and depression, the interesting thing is compassion satisfaction is able to kind of moderate or disrupt the relationship between secondary traumatic stress and anxiety and depression.
But it does not. with burnout and anxiety and depression. So what this translates into, a lot of people who go into the veterinary field, right, we all go in because we're already high on compassion satisfaction. So a person can be burnout and still have high compassion satisfaction.
But what it does with secondary traumatic stress is exposures that they have within the field, compassion satisfaction can kind of stop that from developing into more serious things. Whereas with burnout, the effects of it can be so intense that it doesn't matter how much compassion and satisfaction they have, they're still going to be burnt out and may develop anxiety and depression or other more severe mental illnesses.
So how could... So I'm trying to think of a way to say this a little bit simpler just for my understanding. But no, that was a great explanation. It's very interesting because I... Compassion fatigue is not what I thought it would be whenever I first saw that and I had never actually heard of that terminology, but Obviously, it seems like it is a very big very big issue or topic in the veterinary space because It's the only space that I feel like I've seen that. has such a high majority of people that are actually focused on what you think they'd be focused on. Like, you might have other aims and goals.
Like, I guess the simplest way to put it is you have a bunch of other career paths that people go into probably just because they do it for the paycheck. I feel like the veterinary industry is the literal only one that people if. If they had everything else taken care of, they'd probably still do this just every day, just because they love animals that much.
And I think that's part of why that dynamic is here, or in this industry, is because that is their only focus, is caring for animals. And everything else can sometimes go to the wayside.
And then I guess that is where your study comes in that. even if they're suffering from other mental illness issues, like anxiety and depression, because of that, and maybe I'm wrong, this is me kind of just regurgitating it and trying to think it back out to make sure I understood what you talked about, but because of that, it's able, I guess their love for their work is able to compensate for the... anxiety and depression, but it does not help with burnout. It actually makes it worse. Is that?
I’d say that it makes it worse but it definitely contributes to it.
I was just saying, is it more intensified?
It can be, yeah. And I think these are highly correlated, but we still don't know what causes what. Are they burnt out because they're anxious?
But I think one of the things that I discovered, and this is something that kind of can morph into hundreds of different studies for someone else to do, but is general working conditions, how does that contribute to burnout? Is it the type of practice that they're in? Is it how many hours they work per week? The number of euthanasias that they participate in a day, those types of things can all really have compounding effects, I think, on a human, for sure.
Yeah, now that's the other thing that I'm glad you touched on that, that I never thought about until very recently, but it's the only, I feel like, or one of the very few professions that you see the straight up full life cycle.
If you're in human medicine, the same people that are delivering babies are not the same people that work in hospice. It's separated, but you're going to be in the same practice and you're going to be doing both. So yeah, that must matter. affect your emotions quite a bit. So I have imagined that plays into it as much or more. But so what I guess the final thing I'd like to touch on that is how do you take the research that you did and how are you able or how do you try to positively impact that for the better in your day-to-day. Because not only did you just do a thesis on this, but you're actually still in the field.
And you're probably still, you're not on the front lines, but you're still pretty close, I imagine, with the people that are being affected by this.
One of the things that was really important to me when I got this degree or did this dissertation was to be able to positively impact the clinics at maybe a higher level.
And I think for me, a lot of that comes down to the technicians and the managers. The doctors kind of have their own support system in and of itself. Granted, they still need a lot of attention.
They still need just as much help. And I think for me, it's being able to have honest check-ins with the manager. If they are feeling overwhelmed or feeling like they don't have the tools that they need to do their job well, how can I provide that for them? What resources can I provide? And sometimes it's as simple as, what can I do for you today? What can I take off of your plate?
And not necessarily enabling them to kind of off put everything onto my plate, but being able to help them prioritize and help them with things that can really um, help with their, their education or just general ability, I think, to function.
Yeah, I mean, I think the concept of honest check-ins is always great. I think it's better to do them when they aren't needed because it's able to, I always feel, what is it?
Prevention is a lot better than just, or now I'm trying to think of the quote that I remember, but it's a lot easier to catch things early to help fix them than it is to wait till somebody has a breakdown. And then, yeah, so
I'm a very big believer in that and doing the smaller steps because I think they truly do add up over time to make big impacts.
So I think that's awesome. Is there anything else you kind of want to just really mention and bring home on this before I ask a kind of pivot to a completely different topic?
I mean, I think compassion fatigue is definitely something that has become maybe an overused term in the past couple of years, but I think it's for a really good reason and it shows that there's still so much work to be done.
So if anybody wants to do a study, let me know and we can figure it out together.
Well, I hope that this can reach the right people so that you can actually get those set up.
So I don't want to take up too much more of your time, so I'm only going to ask a few more questions. But just what kind of trends are you seeing in the industry?
And what do not only you, but I guess you, VC, as a whole try and do to adapt to those changes and kind of try and stay ahead of the curve?
One of the things that I think not just UVC, but everyone is paying attention to is maybe a drop in client compliance with inflation and those types of things. When I say compliance, I mean wellness, right?
Are they getting their annual blood work? Are they bringing in a stool sample, getting their heartworm test? Are they purchasing prevention? And who are they purchasing it from? And then I think the other piece of that is how do we as an organization, as a practice, How do we compensate for the increased costs that we're incurring and maybe not giving them directly to the client?
Are there creative ways that we can do that? Because clients are struggling, right, with the way the economy is. And unfortunately, I think the AVMA is predicting things to get worse before they get better. I think the AVMA has done a study, they did it at the end of 2022, I believe, and they saw like a pretty big drop in volume and then it picked back up in the. beginning of 2022. So I think or 2023, excuse me.
So it's going to ebb and flow. Unfortunately, we're going into the summer. So I think things are probably going to pick up as far as, you know, clients just bringing their pets in because they have more time and they're at home. The kids are out of school, those types of things. So it's easier.
But overall, I think we just need to be a little cognizant of, you know, sometimes things might be a little rough, right? It's not always going to be, um, puppies and rainbows, but really being able to strategize how we do business in the times that are good and how do we kind of use those to prepare ourselves for the times things are not so good.
Yeah, and I feel like that's a very interesting point to bring up because I feel like with the COVID adoption boom, that people were riding the waves for a while, and they're probably not used to. trying to, they didn't have to worry about improving compliance because they had so many appointments trying to get in the door that was not on top of mind.
But if you do that enough, a lot will slip through the cracks. And then it's hard to, I guess, pull that back and rein that back in. So no, I think that's a really, really good point to bring up. And it sounds like y'all are doing a good bit to try and drive that compliance home. Is there something in particular that you'll kind of do to help drive compliance that I guess maybe, I don't know if anybody else does it or not, but just what is the else kind of strategy for driving compliance?
In general, I think it's education, right? Is our staff, are they able to, are they understanding what we're trying to accomplish?
And then how do they portray that to our clients, right? Are we sending them reminder emails? What kinds of systems are we using? Are we annoying them because we're sending so many reminders?
Because if you annoy them, they're not gonna call, right? And being able to kind of understand the psychology behind why we're doing these things. of how they not only help our patients, but they also help us, right?
Because we're driving revenue within the practice, and we're also supporting our patients and the community.
Yeah, OK. That's very simple. And I think that's the annoying part is definitely something that a lot of people overlook, is they kind of just blast away and don't think that.
As I like to say, they don't get out of the ivory tower and get in the shoes of the pet owner and saying, hey, would I want to get 30 messages a day or something crazy? Not saying it's obviously that much, but you get the point.
So yeah, no, I think that's. us very, very solid strategy. So what as and I guess I'll close it out with this but um, so what is a bad recommendation that you kind of hear that you would probably disagree with in the industry? And that can be on anything.
It's just something that kind of, we'll call it a contrarian take of yours.
Let's see. I think that a lot of practices, and this is related to burnout, because it's kind of my specialty, I think a lot of practices try to get whatever they can from their staff and overwork them and really don't understand the impact that, the support that they provide or even just someone's kind of previous experiences can have on them in the moment.
Are they able to take a lunch break, right? It seems so simple. But I think a lot of managers just don't understand that and how it can impact people, right? We hire humans, not robots. And so we are driving compliance, but we also need to understand that there's a human that does that. And I think that's where we get into management education. Is the culture toxic? And I think that also has become kind of a trend lately.
But how do we identify those things? and being able to really get in there and figure out what's wrong and how do we fix it.
Yeah, and I think that goes back to, I guess, I'm glad you brought that up because it ties back in with resource optimization. I feel like a lot of ways that practices could... optimize or streamline their practice in a way that their staff can take lunch breaks.
Because that is a pretty big one. And that I'm realizing is actually a lot bigger of a problem than I realize is that some practices are so slammed that nobody can take lunch when it seems like that alone is a huge effector of our cause of burnout. So yeah, no. I think that's a good point to bring up. No, you're good.
Yeah, I think saying like, this is how we've always done it is probably the most damaging thing that could ever be said in any business, but especially in a veterinary practice.
Change is good. It's uncomfortable, but it's good.
I agree. It's the not remembering any of my favorite quotes. What is it the one about where it's something about where tradition is bad.
It's that story where they had a tradition and people are like, just because it's tradition. But
Well, I appreciate you coming on.
Thank you very much.
Is there anything else you might want to say in closing?
Don't be afraid to take risks. I think that's the best way to put it. Sometimes things in practice are uncomfortable, just do it. Sometimes what you want to create is hidden in that fear.
I love that.
That's awesome, and I love hearing that. And I think that's a great way to close it out.
I know you mentioned if anybody wants to do research, is there a particular place that people could find you or contact you if they do want to do that, or I guess for any other potential reasons?
LinkedIn would be perfect.
All righty, well, I'll link that below. But Dr. Carrie, thank you so much for coming on. I really appreciate you sharing your insight, your story, kind of the issues that touch your heart the most.
Thank you everybody for listening to another episode of Vet Clinic Convos, and we will see you next time.
Thank you for having me
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