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VM 360 Google+ hangout on air working with shelters a special online event designed to help private veterinarians and shelters find collaboration in their communities I'm Christy Rymer editor of dvm360 magazine today with me to explore the topping of working with shelters are Dr Jeff wber a private practitioner in the Los Angeles area and Dr Jed Rogers formerly a private practitioner and now senior vice president with the ASPCA so let's get started throughout the hangout if you're watching with us live today feel free to submit questions you can use the comment feature in Google+ or YouTube or the built-in Q&A feature in Google+ so first off I wonder if you could each talk for a few minutes about your own Journey down the path of working with shelters and rescue organizations as veterinarians where are you at now and how did you get there Jed let's go ahead and start with you thanks Christie I appreciate you inviting me to join this Google Hangout my first Google Hangout by the way that I participated in um so I started out as a private practitioner in Hawaii and was there for six years moved to the Denver area and during that time um owned and operated uh 10 veterinary hospitals um most recently owned a group of six hospitals in Denver that I sold to VCA back in 2010 throughout that entire Private Practice career I worked with um local animal welfare organizations shelters rescue groups um TNR groups that sort of thing in various capacities and also with Veterinary associations I was president of the hbma when I was in Hawaii and president of the Colorado VMA when I was here in Denver among other things um and back in 2012 I took the position with the ASPCA as senior vice president of animal health services so in that capacity I oversee uh some fairly large Veterinary programs we have a animal hospital on the Upper East Side of New York City Manhattan um Spain operations we do about 40,000 Spain surgeries in New York and starting this year in LA and then the Animal Poison Control Center which a lot of venerians know and love so um that is my brief history great Jeff tell us how uh where you're at now and how this uh what this journey has been like for you well I started uh practicing back in 84 and I was working for a veterinarian whom I worked with as a technician before veterinary school and um after working together I I think our great engagement never turned into a marriage so we uh I I uh I left and of course as a uh starting practice from scratch I did not buy a practice being very nervous about okay I need to a see patience and how am I gonna how am I gon to get patience well we actually had jedro like to hear this we had an as ASPCA on West Jefferson here in Los Angeles I mean literally a stone throw from my office I said you know what I'm going to go over there and let's see if they need any help let me send my technicians let's teach them um you know even simple things like handling and giving injections because you know as we know most of these um shelters and rescue organizations are are really being run by volunteers so uh I thought if we can lend a helping hand that would be great now I know at the time and it might be still the case that shelters weren't allowed to actually recommend a veterinarian and as members of the Southern California veteran Medical Association all of us had to give free exams to new adop you know adoptees but I figured if I could get a little plug in there just by having me helping them it might be to our benefit not to mention we were so close and sure enough it started working well we were getting a lot of referrals and as a a new doctor with his own practice and a lot of bills to pay we want referrals so uh it was working very well and I really started liking and enjoying the fact um that we were doing this and what I found most interestingly is that clients love to know that their doctor is working with and helping these shelter animals these rescue animals started to snowball and as my practice grew and my location grew and I have a much larger facility now uh we have opened up obviously not to just shelters but also we work with a lot of rescue groups and you know they're good and bad working with rescue groups and shelters um often times we are handcuffed as far as what we can spend what we can do uh we have obviously different pricing we have very demanding people that want to service now even though they're not paying for the full service now um but we sort of uh sort of had the meeting of the minds uh uh and we it's really turned into a great place for us so currently in addition to the shelter work that we do uh we probably work with about six major rescue groups I'm on the board of two of them uh we get a lot of referrals we are the go-to and hopefully that if a uh one of them actually well two of them all adoptors um have to bring their pets to us for that first exam and whether or not they're um geographically desirable or not they at least come once and our job as a care hopefully give them a really good experience and many of them do not have veterinarians and often what happens is they actually have other pets they have other veterinarians but if you play your game right you play your cards right you treat them well show them that you care which is you know I always say one of my favorite lines is people really don't care how much you know until they know how much you care and one a great way to show caring is to help these animals in need Jee that's that's awesome and I think there are a lot of veterinarians out there out there like you who have you know found ways to make this relationship work but here at DVM 360 we get a lot of um we hear a lot of The Angst that's going on among the private practitioner Community um who see these shelters as competition for veterinary services um so jefff in your experience what is the biggest sticking point between veterinarians and the shelter nonprofit community and your experience and observation well you know first of all to us I don't see that as a competition you know let's face it the two um uh factors that what one might compete the most from a shelter and I'd love to hear you know Jed's viewpoint on this too is vaccine and spay neuter well what we did is if you can't beat them join them client and I could tell this to anybody would rather have you provide the care so I would say that veterinarian why don't you provide or offer a vaccine clinic make it one day a week one evening and those clients that really need to save that money and even if you charge $2 more than the shelter they're still going to come to you you're not going to go someplace for two bucks and they're more comfortable with you anyway they know you they know your staff you're giving the injection um it's just i' I've never seen that as a problem far Fay neuter you know I it's like I would say I always use it I I break it out to the car model you know if you want the Rolls-Royce or the Bentley or the the RO the the mercedesbenz of treatment then that's what we provide um if you're happy with the Chevrolet or the Pontiac then then maybe that's where you should go but understand you're not comparing Apples to Apples you want to compare apples to apples are they using laser are they doing pre-operative pain man postoperative pain management pre-operative blood work are the animalss on on fluid during the procedure all these things that as veterinarians we should and need to be doing for the safety of our patients and people have to know that they're just not going to get it there and if they still want to make that choice then that's okay now what we do offer for our rescues and for the brand new adopters who are still under the contract with the rescue is we do have separate pricing for Rescue sper and we are fairly competitive not nearly as competitive as some of these uh lowcost B U clinics can provide but we do provide more service and it's a great way to keep these clients so we done it quickly they they work on our schedule um we you know we we do we cut a few Corners do we offer oral meds instead of injectable meds yes but it's a way to keep these clients in the gr okay Jed what what would you add to that what do you see as the biggest sticking point or do you have anything to add to what Jeff has said yeah I think that uh I think Jeff hitss it on the head and I and love the way that you address that Jeff in your practice because you know you found a way to collaborate um and it's collaboration is always easier than conflict especially in this world that we're talking about um and you know Finding ways that you can work with groups in your community and collaboration doesn't mean that you work with everybody and we're going to talk about that later you find groups that you work with that you're comfortable with uh up to your capacity in your practice you don't have to do this for everybody you find groups that you work with and you find a way that that that that works for everybody and it's it's a great it's a great way to make the Mel work and I agree I think a lot of The Angst um chrisy comes from this world of vaccines and stay neuter and most of the animal welfare groups that are out there there are some a few exceptions here and there but most of those groups are doing those Services um not because they're making money off of them not because uh it's an easy thing for them to do they're doing it because it helps them get the animals into a home and you know it truly is related Mission which ties exactly into what Jeff said you know clients aren't getting those services at an animal welfare organization because that's the place they want to get it they're getting that at the Animal Welfare organization because that organization has chosen to do that to make the animals more adoptable they would rather the vast majority of people would rather come to a private veterinarian for care and the vast majority of animal weal organizations have a vested interest in seeing that their adopted animals get into a private Veterinary situation where they're going to get lifelong care um so I think there are more points of you know collaboration and uh more places where these communities see things the same way than places where they see things differently I think we just hear about the places where there a conflict and there are lots and lots of places where collaboration is is happening that kind of leads right into our next question let's talk a little bit about misperceptions um so Jeff in your opinion what's the biggest misperception the shelter and rescue Community has about the private practitioner Community well I think that they think we're we're too overpriced of course um I don't think they necessarily get it well I think it's better I really do I agree with J I think it's it's much better and the you I'll give you a funny story I uh there was a spay neutal clinic here in town and when I opened um I had my my fees and I remember uh years and years ago one of the um uh vet econ board members had done what does it truly cost a private practitioner to perform a spay or neuter I mean we're talking hard cost Tech time drug cost anesthetic cost you know that whatever it takes whatever goes into it um and it was at the time this is years ago it was something like 79 or 80 bucks hard cost so when when these clinics are doing it for 75 you know it's because they're obviously cutting Corners somewhere they're using the same pack for two or three surgeries at a time they're using the same gowns I mean you know let's face it and and they have to I I get it and my job is to educate our clients as to the differences and let them make an informed decision based on those differences so um I had a um look I we an aha practice a Von award-winning design practice Merit design award so I I I know that we have to stay on the on the sort of the upper range for my area I'm not the highest I'm certainly not the lowest and I had clients that really needed the the help when it comes to Spade neuter so there was a spade Neuter Clinic down the road and uh this guy was amazing he could do a we should all learn from him how to do a spay and uh he would he I I I'd say look you know I understand you can't afford our prices it's not a problem but it's so important to have your pet spade and neuter let me send you down to the Spade neuter clinic and I would send a lot of my clients there and I sent them there with with a lot of of of um confidence that they're coming back I didn't not want them starting to go on the phone at at the time the phone book I know that's a a novel concept now there's no such thing as a phone book but they to open the phone book go into the the the pages look for veterinarians and and hunt for a veteranary hospital that was less expensive than we were why because if they went there for that less expensive spay neuter they automatically would think that everything is less expensive and they are going to maybe consider switching I send it to a spay neuter clinic or lowcost clinic or the asbca they're not going to be there forever they're just going to go there for their surgery and then they're coming back to me so I get a call from this doctor his name is Dr Macky Marvin Mackey and uh he say Jeff hi this is Dr Mackey over the Spain he goes i' like to get together with you for lunch sometime and I said sure that fine with me so we go meet for lunch he tells me he's been practicing in Los Angeles before me for 25 years I am the first veterinarian to actually refer business to and it set up a fantastic relationship because why because when he would have clients come in he would hear them talking and he'd meet them and they were not enamored with their veterinarian and guest who got referrs from the Spain CL so you talk about working together it's the best thing in the world that's great that's great to hear and thanks for kind of illustrating that with some of your personal experience um so Jed let's flip it in your experience what is the biggest misperception nonprofit groups have about veterinarians uh I will answer that question I promis but I I want to mention something about Jeff's story because it's such a I mean it's such a great story I mean I think the the theme here with Jeff is that that he has taken the time the initiative the effort you to get out in the community and and establish these relationships which I think is really the key you to me that's that's the underlying theme in all of these discussions um then specifically with respect to you the cost of surgery Jeff you're absolutely right I you know having owned an operated hospitals for a long time we all know there's a certain cost there that you know if you're going below that cost you're losing money and some people choose to do that consciously in order to you know keep that business in housee the other piece of that puzzle I think is where you have nonprofit organizations like mine who provide SP surgeries at or below cost we have become much more careful about using terminology uh we we don't call those low cost procedures we call them subsidized procedures the only reason we can provide those at such a low price to the consumer is because we have generous donors who have entrusted us with funds to go and do this good work and so then we need to speak about it in the right way because we don't want people in New York or La thinking that you know um 80 bucks is the cost is the price you should be paying for Bay Neu procedure no it's much higher than that we're just lucky that we have donor dollars to defay the cost so that you don't have to pay as much and I think there's power in the way that you speak about those things um and so we we try to be very careful about that uh so back to the actual question Christie sorry uh is I think the biggest misconception amongst the the Animal Welfare Community when it comes to veterians is that venerians are not willing to help um I think that's a big myth and I think there are a lot of animal health organizations out there who um see that as a big barrier or allow it to interfere with their um with their efforts you know if if if we all made the efforts that Jeff has made to reach out into the community and form relationships that that bear fruit over time I think things would be so much better than they are right now and you know I haven't met a single veterinarian in my career who doesn't do a lot of services either discounted or for free uh for their own clients for clients in their Community for in the in the community we often times don't talk about it we don't quantify it we don't use it we don't toot our own horns uh on that subject uh but we do a lot in our communities and I think that in Ware groups um you know I wish that wasn't a misperception because I think there are a lot more veterinarians out there willing to help um and and it's a good resource that sometimes doesn't get utilized in the way it should okay um it seems like at least anecdotally that more and more uh shelters are offering uh Veterinary Services especially like we've talked about spay and neuters but also some Wellness Services as well to the general public without really any kind of proof of income based need um Jed does this match your impression and why do you think this is yeah I think that there are situations like that um and I know that there are groups um around the country who have implemented that model and I think the approach has been you know to incorporate Veterinary Services as a profit Center to help fund the mission of an organization um and this is a place where um I'm going to start speaking uh my own opinions the ASPCA is um is you know obviously has lots of connections throughout the country with lots of different veterinarian shelters rescue groups and this is an issue that we're um grappling with right now and uh we're considering all sides of it my my personal opinion and I don't mean to be flippant here but you know for if you're if you're going out to raise funds um you know Veterinary Services is a really hard way to do it you know what I tell friends who are considering this is you know if you want to make a million dollars on Veterinary Services well you better have $10 million in Revenue you know and and $10 million of veteranary Revenue is not easy to create you know I I personally would rather ask a bunch of people for a million bucks a piece rather than try and create that million bucks with a veterinary hospital so my opinion is you know in the great world of fundraising that veterinary hospitals are not a very effective tool for fundraising that's my personal opinion um I also believe and this is from some personal experience not just at ASPCA but from some other groups that I've been involved with that when you get into the world if you in a nonprofit setting when you try to get into the world of for-profit veter medicine within a nonprofit set setting it almost always pulls you off Mission your your mission as a nonprofit usually in the Animal Welfare world is to help um animals who are in crisis and usually that means helping people who are in crisis and if you move away from that model and start to you know open yourself up to uh you know typical Veterinary you know private Veterinary Hospital clients it's a difficult it's difficult to manage those two you know the mission on on the Animal Welfare nonprofit side is different than the mission on the for profit V side and it's those two things are difficult to bring together in my opinion okay Jeff go ahead yeah I just want to add you know it's interesting how and I I I totally agree and how how I it doesn't concern me at all um and for this reason I I think that when a practice starts out um I think you know it's the clients are coming to US based on whatever it's it's new it's nice looking it's location But ultimately a practice matures and the choice of the type of client base that we maintain is ours we set the standard based on our practice philosophy based on our services that we provide based on the prices Etc and so therefore the type of client that I've built you know to to attract to my practice is not the same client that's looking for not lowcost or subsidized services at a facility like you know any kind of shelter facility you know it's funny I was um a friend of mine from high school is a big time hand surgeon now and um because of the state of medicine as is it is what it is by the way all of us veterinarians listening we should be very happy that we are practicing veterinary medicine and not medicine human medicine and um so I uh I I had a question about something with my hand I went to see him and I it turns out that he is now doing the he is working with insurance companies I'm I'll I'll be more blunt the ambulance Chaser insurance companies so so I walk into his waiting room this guy mean when I knew him years ago when he first started practicing he was very highend I mean and and and he's a phenomenal surgeon but it's tough to make a dollar in medicine so he is doing this insurance work and I walk in his waiting room there must been 30 people in the waiting room clearly clearly not the type of client that I want sitting in my waiting so it certainly attracts a certain type and that's great and for those we need those Services we need that care because every pet deserves to have venerate care and the best that can be afforded so I think that when if I hear that that they want these these these facilities want to open up and start providing venerare fantastic I'm not worried about my clients going there because they won step foot in there and that's sort of the difference so I think it really depends on how we educate our clients to the differen services that we provide to the difference of the equipment that we have and they're going to be totally fine staying with there are great great excellent um Jee I wonder if we could go back a little bit to um your how what you mentioned earlier about identifying certain rescue groups that you've uh decided to work with how what was your process like for deciding who were you were going to work with and also how many of those um people become long-term clients at your practice you know so first of all I would say it's very mutual that that and it's it's very clear you talk to any veterinarian who's done it who's tried it who is currently doing it in fact if I were to mention certain names of rescue group people to the other rescue groups that I work with they are going to have the same reaction that I would have so certain groups have developed a reputation certain groups have developed a a um uh a a personality traits that are Unbecoming and it's really nice when you're doing the work that we do the the the most important thing obviously patient care helping these animals but we want to be appreciated you know it's really nice when you're going out of your way to help somebody you're going to break even at best you're going to make it maybe make a few dollars but we're not doing it for that reason we're doing it to help these animals and hopefully ultimately to build client base so at the very least appreciate it and when they become too demanding when you allow them you know give an inch take a mile when they will you you you allow them the opportunity to pay me next week and then next week turns into two weeks and then to two months and then to six months and then when you just call them and say hey guys it's been a while we I I hate to say no to your the people you send us but we may have to then they start getting mad at you that's a person we don't want to work with so and it's very clear so the groups that we keep now and I said we have about five or six and interestingly talk about the importance of the doctor not necessarily the facility is that one of um a group that I used to work with long time ago look we're busy practice um they kind of went to maybe using us 20% and went someone else for 80% it was all amicable and I said look if you need us we're here for you whatever and it became more of a location thing yes the doctor they were working with left where did he go to me so now I have about three or four new rescue groups that were working with him and now they're all coming to us so it just shows the importance of to maintain those relationships as I said don't burn Bridges unless you really want to keep your nose clean and it's only going to help so there is I'd say as far as numbers of clients it really boils boils down to a number of factors location is obviously they have to be geographically desirable um if I keep 50% I'm thrilled all right great je uh Jed anything that you want to chime in on there sure um you know I think I think a big part of the equation when it comes to veter practices working with animal organizations in their Community is clear expectations on both sides uh you know what how's it going to work um how how many patients is there a Dollar limit what kind of services all those things need to be discussed fairly thoroughly and to do that you need a relationship you know you need to De develop a relationship over time you need to have some face Toof face and some real detail you know figured out around those relationships so that everybody is happy long term and and it has to be done within the uh the limitations of of both the veterinary hospital and the the animal organization everybody has to be comfortable with where that starts if you want it to last long term um I as Jeff was talking and you you saying 50% you're happy with Jeff I remember a meeting I was at here in Denver when I first moved here um 15 years ago talking about the um pre first exam program and Denver has a very strong program uh well well utilized and lots ofans participate in that and I remember talking to a veterinarian who was frustrated because um the estimate at that point was that only seven out of the 10 you know free veterinary exam clients who came in actually remained clients and I kind of I at that time you know I was thinking to myself that sounds pretty good to me like like where do you sign me up I want to sign up for this thing and and yet this practitioner was looking at it as he was frustrated that he had to give those three exams out of 10 and he never saw the clients again well you know seven you know seven lifetime the value of that for you the hundred bucks that he had to pay to put his name in the book my God you know it's it's a it's a pretty good business equation I I agree and I totally agree also uh Jed that we need to set out the ground rules at the beginning to avoid conflict uh down the road um but you know you know overall it's it's been a teric and one thing also do and I and I like to cheat I think right now um the internet plays a major role in people's attitudes you you know I look at kids nowadays where where asking about something about a product or about a service provider a restaurant and I mean there there's it's a knee-jerk reflex out comes the phone you know and they're already punching in they'll give you an answer in two seconds so I am not proud when it comes to these things and we we always ask um that because of the work we're doing because of the help we're providing you we ask these rescue organizations these welfare agencies promote us just put a little blog about how happy what we did we know save Dr wber sent V Group whatever saved this dog and show pictures people love to see that and if they're not doing it on their own ask them to do it you may as well take advantage you are giving up a lot as a veterinarian as a doctor as a practitioner to help these rescue agencies and you need to be rewarded and it's not only coming from obviously the financial aspect coming from that agency so it's it's our reward of the clients that stay and it's the other clients that see all the good work that we do that think about consider switching their providers as well yeah AB absolutely and I think um I've seen a lot of practices recently who even though they're uncomfortable doing you know a press release or you doing something um over the toop that talks about their work with in the Animal Welfare Community um they are comfortable you know posting those things on um you know Facebook or or Twitter or Google Plus and and then asking the social media Folks at these groups hey you know if we if we tweet something retweet tweeted or you know share you know share our Facebook post with your with your network I mean there one of the great things about a lot of these groups is uh they have a lot of followers and they have a lot of people who are interested in their work and if you can get access to that social media stream why not I mean that's not why you do it I think Jeff you mentioned that before you do it because you you want to be a valuable part of your community I mean ultimately every veterinary hospital no matter how big it is is part of a small community with you know maybe within a larger Community but you want to do the right thing for the community if if it helps you get business and develop your client base over time that's great uh and you shouldn't feel embarrassed about leveraging it for that um it's I think that's part of the the the relationship that makes me think that uh that would be a great opportunity for team members to get involved especially on the social media side of things they're often a lot more um open to that kind of thing than than the veterinarians is that something for a question for both of you something that team members could kind of take a role in or are there other ways that they could help Forge these connections well I I totally agree with you chrisy that that our team members do get involved and I like them sharing stories with their circle of friends on Facebook when we saw a difficult case when we had a uh a dog came in from one of the rescue agencies it was literally mauled name was Henry Henry was all over the Internet we have pictures we're talking a dog whose trachea was was was literally chewed through we had to sew the trachea back together and over time the the skin defect the infection the the granulation bed we took we took sequential pictures along the way and now Henry's in a happy home so um it is yes so the the key is your staff should be and and should want to do it because they're great stories to share people love to hear these Feelgood stories and um it only it helps us and it helps position us as people that really care about the animals that we see in tree yeah and I I agree I think there's nothing nothing better than to involve the staff in that because they're the ones who uh you who took care of those animals and they should be proud of the work that they did um and and the other thing the only thing I'll add to that is that I know you know it's all going to be done within the context of the social media rules on both sides sometimes you're dealing with you know client-owned animals that uh you need to make sure the clients are okay with you sharing that information and sometimes with Animal Welfare organizations if they do investigations there's some sensitivities around sharing that info but you know as long as you take care of those details to me the more the better I mean I think you know spreading those stories who doesn't love a great animal story you know everybody does okay shifting gears a little bit um Jed in past conversations you have talked to me about who are private practitioners who call you to complain about nonprofit Veterinary work going on in their communities and you have a very specific suggestion for those people can you tell us what that is and what the results have been yes so my my I'm not going to curse on even on Google Hangout but my smart alec answer to that is you know that the you know whenever I have friends who complain about that and I know there are a lot of veterians who who feel like Animal Welfare organizations I'm sort of duck behind the mission you know it's all Mission related so we can do whatever we want to to a large extent um animal Weare organizations nonprofits are driven by Mission and they have something that they are trying to accomplish and a lot of a lot of Animal Welfare organizations are trying to um you know get animals into homes into lifelong homes and so my recommendation for my friends who are frustrated is you pick the open admission shelter in your community and then go there and do euth in Asia for a day and um you know I I've only had um two people take me up on that in 20 years but I've done it in in multiple cities and it is um it's a sobering experience you know it really brings you right back to the reality of what these folks are dealing with every day and to me there's no more courageous person than than somebody who works in an open admission shelter because they are tasked with the community issue of unwanted animals and you always I always hate when people talk about you know shelters euthanizing animals that you know shelter May perform the use of euthanasia but that's those are communities that are euthanizing animals and it's a community issue and to me Comm is much bigger than the shelter and um and so you know that's that's my standard line most people who know me have heard it enough that they kind of their eyes glaze over or they roll their eyes when I when I bring that story up but that's that's my go-to request for them when they and you've had some people take you up on that right I've had two people take me up on it and um both of those people um came back after the experience and thanked me number one um and then told me about their experience usually you know the one of them never cries the other one was in tears and um it was you know it was a profoundly impactful experience for both of those people and and not that that's you know you you can't boil what we're talking about down to one experience um and at the same time I think that's a pretty powerful experience to have to help Private Practice veterians understand what these Animal Welfare groups and all the people not just veterinarians but all the people who work for Animal Welfare groups have to Grapple with the issue of euthanasia you know even no kill groups have to Grapple with the issue of euthanasia and animal death and it's not easy for anybody Jeff anything to add to that well I mean if they were to ask me um and I think Jed made the point earlier I would I would certainly uh promote the idea I do because I do it myself um but I would let them know that if you are considering this and if you're a new practitioner and you're and you're looking for obviously something to do well for the community um something to help build your practice um to go out there and let the rest of your world know that you're available but the ground rules are probably the most important I'd say most of the issues that we've had with the the the the unsuccessful relationships have been we didn't lay the ground rules down clearly enough um and you know let's you know I understand their position and the position of a shelter weal organization the budgets aren't always there and they look to cut corners and they look for anything they can do to get something for nothing um I know their rationale is they're doing it on behalf of the of the animals that they're trying to save another thing that that I I want to mention and and and I think that that we as veterinarians have to to pick a harder line approach and that is the following the volun people that get into rescue work are also not really doing it for the money all right so so they have what I refer to as the bleeding heart which is great we should all have bleeding hearts anyone who works with animals veterinarians should up leading arts and that's why those of us that do work with these groups it's it's because of that however when you look at the number depending on the city depending on the the the the municipalities and their own um rules and regulations there are is a limited number of space in these shelters and I am always trying to prevent my rescue groups from going in and adopting and pulling out these animals that are going to be relatively unadoptable where that need a lot of medical care a lot of work to put them back together just to get them to the point of being adopted often these animals are on the older side and in the place of that one animal and the money that's going to be spent on that one animal there might be 30 more that are ready to be adopted tomorrow in perfect health that you're going to get let languish and ultimately be destroyed while you're trying to save the one if you're going to work in this industry I believe as tough as it is and it hard as it sounds we have to adopt a herd Health mentality which is where we have to sacrifice the few for the benefit of the many and it's the hardest lesson that I have to work with when I talk to these people it's like why are you doing this you're you're going to spend $1,000 on a dog that is probably not even get adopted or might die anyway and you know how any animals we can pull out today for $1,000 so that's my difficulty um I get to sit on it because I'm here and go go hang out with you guys but I would like to make sure and I you're curious dad what do you think about this yeah you know Jeff I think that the uh the concept of how you apply resources uh to you know animals that are in need of homes is something that a lot of um the shelters rescue groups other animal organizations grapple with daily what where I think there's significant value again this is I mean I'm sounding like a broken record here but Jeff you have a good enough relationship with the groups that you work with you can have that Frank conversation with them and be their advisor and and be able to say hey this is this is what this is going to cost we we can go down this path and here's what's going to C here's what it's going to cost to get this this animal to an adoptable Point uh there's significant care after that is this really the best use of resources here and so you can at least inject um some reality into that equation so that the groups that you work with can make educated decisions now you unless you're running the group you don't get to make that decision but you have a huge amount of influence I think um that's that's a great role for veterinarians we can be constructive in that argument discussion as well um you know shelters across the country make those decisions every day and um you know they're they're thankfully there are a lot of big cities that have uh significant success that are much better off than they were 10 years ago or 15 years ago there's some places where the live release rate even in large communities is in the 80 and 90% range which I know I still find incredible and i' I've only been doing this for for 20 years but you still have to make hard decisions and I think when you have to make hard decisions doing that with as much information and data and reality as you can is a valuable thing and V can be a great part of that discussion so um either of you I guess we'll start with Jeff do you think that um refusing uh to collaborate with shelters or even directly opposing them in a local community uh hurts veterinarians and if so how and why um I I definitely do think it hurts because you know it's it's you go online and you hear stories that have been in the media lately and you hear the negative aspects of of private practice at least veter medicine how we are you know in it for the money we really don't care um and uh we gouge people um because we can and I think that the relationships that you build with these organizations shows that no no no no that's not true we we charge what we do because we have to maintain our facilities and our equipment and our staff and we have to pay them well so they continue to want to work um and let's face it you know I I look at the cost of running a business and Jed mentioned earlier I guarantee back when you owned your practices you would have been thrilled with the net dollars um whereas now you see that net dropping and dropping and dropping because the cost of providing Services goes up and we cannot in our fees keep up with that um that rise so it's not true that that we're out there just for the money and I think that working with these agencies and shelters is what's going to help show the public that wait a second time out we are here because we care and we care about these animals we care about their welfare we we want to do what we can to help and obviously it's got to be in reason we are not subsidized we are not a nonprofit and therefore we can't do it for free or for as some of these other places can but we do what we can't do so I think it does give the wrong impression when a veterinarian says no no no I'm not going to I'm not going to work with do blanket statement now if you have a discussion with them and say we've tried this before here is how and why we failed we would love to do this but this is what we really need to to lay out and to prevent that failure again then we would be willing to revisit and reevaluate so I think that's where Bo answer okay J do you have is this something that you have seen in your experience of um veterinarians actually hurting themselves by directly taking on the shelter Community yes and that you know I've been fortunate enough to have grown up as a veteran in Honolulu which is a a good community that has fairly good relationships and then I I happen to come to Denver which is exemplary in terms of the way that veterinarians and and the larger Animal Welfare Community work together but um yeah you see examples of it in lots of places and it's unfortunate I think that it's uh it's not helpful for the veterinary Community to get sideways with uh with the Animal Welfare Community I think it's it's harmful to the veter community honestly and I think it when that happens excuse me when that happens I think it's easy for the public to jump to the place that Jeff was just saying you know oh it's greedy veterinarians gouging the public that kind of stuff you know whereas if you you can tell a great story like Jeff can on an individual practice basis hey we work with this shelter and these five rescue groups in a deep meaningful way or as a community as a Veterinary Community you can say we do these four things to help and support our Animal Welfare organizations in our community it's much much better um and you know short of that at least being neutral you know there are situations where um you know it's just not going to work and and I think you know if if a veterinarian in a community um just can't work with their local animal welfare organization despite many many attempts then you can at least be neutral and uh you know Live and Let Live and Do Your Own Thing focus on what you can do and let them focus on what they're doing but you know there's no reason to get sideways and and cause a PR nightmare a couple places around the country where that's happening right now and it just I I feel bad for everybody in those communities because it's just it's you know it creates ill will right right okay just a quick reminder to our live audience um if you have a question and you'd like to submit it um there are a couple ways you can do that on Google+ just press the Q&A icon and then type your question on the right side of your screen if you're watching on YouTube you can just add a comment right at the bottom of the page and we'll get to that Q&A time in a little bit um so we've talked a lot about kind of the way things can really work optimally but are there anything are there any other best practices that we should talk to our audience about um showing that showcase how a private practitioner and a shelter rescue rescue group can work hand inand either of you can jump in well you know I think we covered you know most of it um in the sense that it is first of all let let the rescue group know that you're willing and able and available uh set the ground rules and and again I've talked to some veterinarians that say okay for any given rescue group we can offer up to five runs or five cages um you know just having having a set number when when to pay we used to we used to settle up if you will once a month now we try to do it every Friday we keep a credit card on file um they get to we we send them the bill Thursday evening they get to review it uh we talk about whatever was supposed to be done at a discount and maybe wasn't or more of a discount or less of a whatever and then once they give the approval it goes in so I think I think we we still run a business here we have to we have to keep those things in mind um but I will tell you you meet really great people I was just at big event for one of the groups that we work with uh they had their annual fundraising event I'm on their board um they you know I was I was up on the big screen so so other people it's it really is and I and I can't tell you enough it it really you can use it to your advantage to promote the work that you do people who who see what you do I have one of my better clients and I'm here in LA and Hollywood uh definitely a Hollywood figure that I actually met at one such event and now I take care of their five pets so it is it definitely works and and people love when they see what you do on behalf of the animals and they hear the relationship you have with these groups they it just they get excited and they they want to piece of it so um I I my encouragement would be to do it if you haven't if if it's been unsuccessful try it again but change the rules to make it work for you um but I think the relationships are important to maintain yeah and I what Jeff said Jeff what you said at the very end there I think resonates with me in a big way that you know this I I the recommendations I always make either to animal healthare organizations or veterinarians most the time both as they're getting involved in these kinds of things are one this is not a small undertaking you this is a significant effort and you should treat it as such you you need a plan you need to you know dedicate some resources time you know usually doesn't take a lot of money but time money um to to get the relationships going and to maintain them and then the other thing is you have to have patience I mean I think that often times these veterians and Animal Welfare organizations come together and you know have a different languages or they're they're going after different goals and it takes a to work through those issues and so you know I I hear from veterians a lot and animal wealth organizations who say you know I I I emailed that person they never got back to me I called them left a message they never got back to me well don't give up after one try you know put a little more more effort into it and uh you know it may take a little while it may take longer than you think you may not end up with exactly the relationship that you wanted but as long as you end up with something that works for you um and that has to be maintained and reviewed over time so that it's working for everybody as long as you end up with something that's working for you like Jeff said it can be a great thing it it leads to all these unexpected things uh in addition to you know the things that you expect out of the relationship sometimes you get some Great Unexpected benefits like your Hollywood client J so the themes that I hear are persistence managing expectations and lots of communication absolutely those are uh and they're all I think that if you you learn from others mistakes I mean it's always great to ask them who have you worked with in the past what didn't work and that way because you know very few of these rescue groups have never seen a veterinarian before so they worked with someplace and what amazes me is how few veterinarians are now willing to work because of their bad experiences uh or they say oh yeah I us they used to give us a a 10% discount you know that's not special enough for them um and uh I think that there are ways that we can do to make it work for us and it's really for me it's it's providing the care um it's great to have these animals that really need help I have you know if you ask a veterinarian for example uh what is one of the uh dogs that you fear the most as far as aggression and on that list there are a lot of them I mean certainly we know that Chihuahua are land sharks but but one of the the um dogs that that is really just not a great dog that's very one person or one family oriented that loves to bite veterinarians and that's a Chow Chow well I have a rescue group that and if I tell you the Chows that she finds and pulls not one not two but 90% of them actually read the golden retriever book by mistake they are the most amazing dogs and to take these dog dogs and give them you know fix them clean them it's it's amazing you see these dogs and the dog have seem to appreciated just as much and um I said it that's rewarding I mean that's why we do what we do and when you see that and you see this owner who now has this fantastic dog it just it it makes you feel good and I think that's why I would encourage veterinarians to get involved that's great that's great there's a personal aspect to it that can be very rewarding um so we're now ready for the Q&A uh sess part of our hangout um if you're part of our live audience just um press the Q and icon in Google+ or add a comment in YouTube and our moderators will get it in the CU so our first question is less of a question and more of a heartfelt experience the viewer says I worked at a nonprofit Vet Clinic um some Veterinary facilities look at us as competition however we had clients that may not otherwise have had the opportunity to vaccinate or provide basic veterinary care for their pets um thoughts on I imagine this is not a very not an uncommon uh thing that you hear you know we I I we discussed this earlier and and it's so true and um I you they I think it depends on the type of practice you have I would say this the greater the you have to think about this for a second the greater the difference between the care and the facility and the service one provides to that type of service the less likely it's GNA that service is going to make a dent now if you have a hospital that is kind of on the lowc cost side it's a high volume lowc cost practice right and then so these client it's a different expectation that these clients already have so to go to one step lower and and to an ASPCA or a a shelter that is offering Veterinary Services full care veter servic may not be as much of a of a of a change and they might be willing to do it but you develop a client base that wouldn't that I'm glad like mine uh they're not going to they're not going to look at that I mean they wouldn't want it for themselves it's like I say to a client considering the uh a low a really low cost or a subsidized spay as as Jed would put it um if you were sick or if one of your kids was sick you want to go to Teter sin which is our big fancy hospital here or would you want to go to the LA pre Clinic there's your answer so it's the same thing yeah and I uh I agree with Jeff I think that you know we our Hospital in New York City provides care to um to pet owners in New York and um you know we have decided as an organization to provide a high level of care there um which kind of gets it back to Jeff was saying you the two ways that you can provide you know Care at a low cost to the client or a low price to the client I should say one is to subsidize it with generous donors or to provide a different level of care and you we've chosen to provide a high level of care in New York City we also uh make sure that the people we're serving are the people who need our help um we're not perfect at that by any means and we we go through constant um efforts to refine the way in which we identify those clients um and the folks who come in and sit in our waiting room on 92nd Street are not clients were going to go to Jeff's practice they they can't they they're not they can't afford it they usually haven't gotten much or any veterinary care for their for their pets um and that's who we want to serve and so that comment I feel for you um I know how that feels and at the same time you know when you work for a nonprofit that is a mission related organization you know you're your your profit is the accomplishment of your mission um take heart in that if you're doing good work for the clients and patients that your organization has chosen to serve then who cares the other veterans think you know you're you're doing what you've set out to do and you should be proud of that no matter what the veterinary Community thinks of great thank you both um our next question is for Jeff um you mentioned that you think uh spay neuter clinics must be cutting some Corners to keep costs low but couldn't spay neuter clinics cut back on cost through efficiencies and improved surgical skills based on the number that of surgeries they're doing oh absolutely and um I think that the the the word that uh Jed used earlier the subsidization versus the low cost I think is great um but I also know from uh seeing some of these in operation and I'm it it it probably is not across the board there are some efficiencies if you will in just how um packs are used how um uh surgical grounds and gra drapes are used um where there there probably are some cost savings that are being applied just in their day-to-day not that it's bad I mean you know there's there's there's a um oh and I forget the name of it there's a a web series on now uh of of Surgeons that are in in the you know 30s and 40s right and they would go in there into a belly with no glove yeah is it is it the end of the world no uh to change your gloves and not to change your gown and and and have them assembly line that's fine uh and it's going to help save money which is of course what needs to be done so I'm not saying this is a bad thing but I I don't know if if the and are they using post-operative pain medication injectivity for each animal are there is every animal onural fluids you know if it is great if they can do that and charge what they do all power right but I would be very surprised if uh if they can without being subsidized D what do you think I think that's I think that's right Jeff and I think a couple things to add there one is that the association of shelter veterinarians published um guidelines standards for um high quality high volume spay neuter operations back in 2008 they're being revised I understand this year and and hopefully they will be the updated version will be out next uh next year in 2015 those were published in javma um and I can provide you a link um Christy if you want but you know that the guidelines are clear and you know asbca and a lot of other animal healthare organizations um want those standards to be held up I me if you're going to be doing these procedures they need to be done at a certain quality and you need to consider surgical technique pain medication anesthesia in a in a comprehensive way and um you know there are groups out there who are phenomenal at this I mean I know Humane Alliance in North Carolina is oration that trains um veterinarians who were doing this um as a as a career they also train private veter students um in the techniques and so to to the question um Yes actually you know high quality high volume spay neuter and I I'm laughing because we're we're a a business of acronyms and that's one that you'll see HQ hbsn um is something that has been around for a long time and it's a very serious Medical ever that that there are lots of people out there who have thought long and hard about and you can do high quality medicine in a very efficient way that that then leads things um so it it's possible to do these surgeries in a very efficient way uh that from a medical standpoint is achieves a suitable level of care in my opinion and that's what the good groups are doing you know the good groups are out there doing not only efficient surgeries they're also doing uh you know high quality of medical service when they do these procedures so one thing a veterinarian could do was find out who those groups are that are adhering to those standards and refer when they have the opportunity to those organizations that's correct and you know Human Alliance has a great web page they also have I think in the neighborhood of 130 clinics that they've trained around the the country and they they train you know teams veterinarians technicians and plant service folks um in in all aspects of high quality high volume spay neuter but that's a that's a great place to start but I think that's a good uh suggestion chrisy is that if you have one of those facilities in your community or if you have another group that's doing high quality high high volume those are great groups to um to talk to about how that's accomplished right well that is all the time we have for questions today um this is been dbm 360's Google hangout on air on working with shelters uh if you want to see this again or missed any part of of it you'll find it archived dvm360.com shelter hangout along with many other stories articles tools and advice on working with shelters and rescues um I'm Christy Rymer again editor of dvm360 magazine I'd like to say a big thank you to our participants Dr Jeff warber and Dr Jed Rogers and to all of you for watching and participating thanks very much here thank you thank you