Feb. 15, 2025

#137: Why Emergency Vets Quit (Spoiler Alert: It’s Not What You Think!) With Dr Matt Booth

#137: Why Emergency Vets Quit (Spoiler Alert: It’s Not What You Think!) With Dr Matt Booth

In this episode, we break down a groundbreaking survey on ER vet retention—uncovering the biggest reasons professionals leave the field and, more importantly, how to keep them.
Our guest, Dr. Matt Booth, reveals the “Five Buckets” that determine whether an ER vet stays or quits: ✅ Leadership(the #1 predictor of retention!)
✅ Schedule flexibility (is a 4-day workweek the answer?)
✅ Professional growth (including alternative board certification paths)
✅ Work culture (how toxic environments drive burnout)
✅ Medical support (not as straightforward as it sound! )
You'll also learn:
🔹 The surprising link between gender disparities and retention.
🔹 How to value your vets beyond what they're billing.
🔹 How mentorship can make or break a hospital’s team
If you’re an ER vet, manager, or industry leader—this episode is a must-listen. Tune in for real solutions to keep veterinary professionals happy, supported, and thriving in their careers.

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Season 1

Most vets believe it’s inevitable—on average, they leave Emergency and Critical Care (ECC) after just 3-5 years. The obvious culprit? Shift work, right?

But what if that’s just scratching the surface?

In this episode, I sit down with Dr. Matt Booth, ER Practice Development Lead at Ethos Veterinary Health, to break down surprising findings from his survey of 3,500 emergency veterinarians. Together, we explore the Five Buckets of Retention—the REAL factors that determine whether your career in emergency medicine thrives or fizzles out. Spoiler: It’s not all about night shifts and burnout.

We dig into leadership challenges, the keys to professional growth, and how these insights apply beyond ECC to every role in veterinary medicine.

You’ll also catch highlights from my previous chat with Dr. Matt at IVECCS 2023, where we shared actionable strategies for improving recruitment and building sustainable veterinary careers.

Whether you’re an ER vet looking for longevity or a practice leader aiming to attract and retain top talent, this episode is your guide to rethinking retention and career sustainability in veterinary medicine.

Topics and Timestamps:

00:40 Meet Dr. Matt Booth and the Five Buckets03:47 Recruitment Insights from 202307:36 Survey Findings and Retention Strategies12:07 The Five Buckets of Retention27:07 The Burden of Being a Giver28:23 Creative Solutions for Employee Retention29:04 Leadership and Gender Representation39:59 The Role of paid time off in Retention43:40 Creating a Positive Work Environment46:37 Professional Educational Growth

Join me at JAVECCS Tokyo on 15 and 16 March, and at IVECCS 2025 in San Diego on 4-8 Septembet.

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The Five Buckets of ER Vet Retention: What Keeps Veterinarians in Emergency Practice?
The "five buckets" are factors that explain 60% of what would retain an emergency room (ER) veterinarian for a long period. An ER practice that appropriately implements these five factors has a statistically significant chance of retaining an ER vet for a long period.
The five buckets for ER vet retention are:
  • Schedule. Shift work and after-hours work are potential reasons why people leave ER roles. Schedule also includes flexibility and autonomy.
  • Opportunities for professional educational growth. Feeling stuck is a common feeling for ER veterinarians.
  • Environmental tone/atmosphere. This bucket can also be referred to as culture. Toxic work environments often originate from leadership. An environment where a positive attitude is a high priority is a factor for retention.
  • Medical support. Medical support means having someone to call. The needs of a veterinarian in their first year compared to the middle or end of their career are very different.
  • Leadership. Leadership is the most important factor and drives a lot of the other buckets. Leadership involves leading the team, asking questions, and being curious. Leaders recognizing the value that ER vets bring to the practice is the most important factor in fostering a work environment conducive to long-term employment.
Balancing Work and Life in ER Medicine: The Power of Leaving on Time:
To achieve a long and meaningful career as an ER vet, prioritising leaving on time is critical. Setting boundaries and leaving on time creates a sustainable environment, and normalises this behaviour for others, but it requires support from leadership.
Additional insights on factors influencing work-life balance in ER medicine:
  • The Five Buckets The five buckets that explain 60% of what would retain an ER veterinarian for a long period are schedule, opportunities for professional educational growth, culture, medical support, and leadership.
  • Schedule Considerations The schedule bucket incorporates shift work, after-hours work, flexibility and autonomy. Yes, ER vets know what they signed up for but they should still be supported in their need for time off, but flexibility for paid time off (PTO) is an important factor for retention.
  • Culture Creating a positive environment where everyone feels valued and respected is key. A positive attitude should be a high priority.
  • Leadership Effective leadership involves recognising the value that ER vets bring to the practice, and leadership drives a lot of the other buckets.
If you had to guess the number one reason why most emergency vets eventually quit working in ECC, what do you think it would be?No, it's not that you were thinking that it's the after hours, right?That's one of them for sure.But scheduling is just one of what Doctor Matt Booth and his team of researchers identified as the five buckets of staff retention.
And once you hear the other four reasons, you're going to see that this does not just apply to emergency vetting.OK, I'll put you out of your misery.The number one reason why emergency vets quit their jobs in ECC is.Leadership with that purchase number one thing.
See, I told you it applies to all levels of veterinary practice.I'm Ebert Himstrat and you are listening to The Vet Vault, where I find the people who commit their lives to making life for others in the vet profession better and then badger them with questions so that you can use their expertise in your career.
And in this episode, we are exploring those five buckets of staff retention, specifically an emergency practice.But beyond night shifts, you'll see that it's totally relevant to your job and your team.But first, a quick bit of background.This episode is made-up of two recordings separated by just over a year.
I first chatted to Doctor Matt Booth, who is the ER Practice Development Lead at Ethos Veterinary Health and also a former ER veterinary hospital founder, and for the first time at IVEX 2023, about recruitment.It was the tail end of COVID and everyone was still in a mad scramble for more hands on deck to handle that deluge of new clients that most of us saw.
Recruitment.How do we attract more vets was the hot topic and Matt was presenting about it at IVEX and I got to interview him about that talk.The problem is that sometimes I tend to have more conversations that I can realistically edit, so this recording set in my To be Edited folder until I met Matt again at IVX 2024.
But what had happened between those two interviews was that the global economy had changed drastically, and while that deluge of clients didn't quite dry up, it sure slowed down for most of us.The result is that many vet clinics are actually pretty well staffed.So Round 2 with Matt at IVX 2024 focused more on her retention.
How do we stop the team that we now have from quitting?Interview 2 covers the findings of a giant survey of more than 3500 practising ER vets that Matt and his team did in that one year gap between the two interviews.The results of that survey shines some light into the dark corners of emergency vetting to find out what really makes ER vets tick and specifically what makes them quit, or ideally not quit.
By the way, Speaking of IVEX, which if you don't know what it is, it is the epic international conference of the Veterinary Emergency Critical Care Society.I've just confirmed this week that I will be back at IVEX again this year.Mike in hand is the official podcast of IVEX interviewing more amazing speakers and generally having a lot of fun.
You should come and join me and say hi.This year it is on the 4th to the 8th of September in San Diego, which of course in German means a whales vagina.If you don't get that joke, you are uneducated and you should go to watch Anchorman.
I'm also going to the Japanese Veterinary and Emergency Critical Case Society Conference Javix in Tokyo on the 14th and 15th of March.Yes, that's like 3 weeks away, but if you're on this side of the world, you can still make last minute plans to come and see the cherry blossoms with me while topping up on some world class continuing education, but I digress.
So this is how we're going to run this episode.I'm going to share some of the content from that first chat about recruitment because we still want to recruit at times, right?And I think what Matt told us in that first chat is very useful and very much still relevant.And then we'll explore the findings of that study that Matt and his team did about the five buckets of retention.
So here we go.Doctor Matt Booth, 2023 on recruitment.I want to emphasize we need to have grace with ourselves.
The leaders need to have grace with themselves, and the leaders of the leaders need to have grace with the leaders and really understand that we need to pull off bite sized portions.Even with what I present, there's going to be a lot of stuff there.And I have a feeling some people are really like, yeah, that's great, I can do that and I can do this and I can do that.
And then they might get paralyzed by the fact that.When I ran my hospital, I constantly felt like that.But there's many things I want to do, yeah.But you know, when you open that abdomen up and it's and you're shocked by what you're seeing, immediately, the first thing you have to do is take a breath.And if something's bubbling, you know, if something's obviously believing, you might want to put your finger on it and sit there for a second, right?
And just hang tight and then just go back to what's step one.And once you get one step kind of in the direction you want it to go into, we can help you find another partner to move to the next step.Do you find this?Are they common things that you like?If you had to list the the top couple of things that people are missing out on that they are blind to within their own organizations.
The number one the number one place to point the arrow is a highly trained support staff to create a highly trained support staff CSRS, Virginia's and technicians VTSS that is without question the.
CSR.Let's go through them.CSR customer support.VAT assistance, right?Yeah, technicians and BTS technician and I would, I honestly would lean in predominantly into the that whole VA Tech area as the greatest need with the greatest potential for us to have thriving careers.
Do you all have any idea what the number one factor for recruiting currently practicing ER vets in the US non DAC backs is?If I said I'm asking, currently practicing so not students interested but actually currently practicing emergency veterinarians in the US that are not DAC backs, what is the number one thing in a hospital that they want?
Did you just give us the answer before when you said you're right?That's.Right, that's right.So here's an interesting thing.Back in my day, which is a long, long time ago, but I'll bet some of these people listening can relate to this.We wanted to make sure they had all the analgesics that we were supposed to have in the hospital and all the cool toys.
And that's what we were told to go look for.But think about this for a second.We're struggling with obtaining, recruiting, retaining staff, technical staff, veterinary assistant staff, and one of the, and obviously, let's be clear, they have to be paid a wage that's going to allow them to thrive.
OK, So that, that's, that needs to be understood regardless of this job or another job, but one of the biggest factors for them is to have autonomy, mastery and purpose.And that those are the ways that they can continue to thrive.And then by what will then happen is that we'll be able to recruit these amazing ER veterinarians and create an environment for them to thrive so they can then practice their highest level and then they continue to grow as professionals.
It says the reason for that, that if you don't feel well supported and the cognitive.Load is too much, the pressure's too much on the vet.You're primarily responsible and it just gets, well, I was exhausting.I'll just the truth of the matter is I don't know that anyone's ever asked those questions.
And I think the truth is Hubert is we should ask those questions.We should continue the questions.And I think it needs to go on beyond today and tomorrow.So the key is to comprehensive data gathering.Hear their voices, stop telling them what they want.
OK, Fast forward a year and Matt and his team did exactly what he said here.They asked people what they wanted, the survey went out, the responses came in, and they analysed the results.Here's our second conversation where we talk about what we can learn from that data.
So when we talked last time, you were marketing and talking about a big survey that you were going to run, and that was what the survey was about, right?Am I remembering correctly?It was about retention in ECC.Why are people leaving?I think when we really wrote it down, what we were able to find out was I think there was a portion of this study it was about recruitment and then a portion of the study that was about retention of ER vets specifically.
And we've taken a lot of that data and we've, we've created goals or we call them the five buckets.And then the, the goal is to teach everybody about these different 5 buckets for specifically ER vet retention.
And within that, if a company or an ER practice can appropriately implement these five buckets, they have a higher chances of significant, statistically significant chance of retaining an ER vet for a long period of time.And from that information, what's transpired is a lot of the work that I've been doing now, besides helping to guide people back towards these five buckets, is more towards one of the buckets being professional educational growth.
That one's the one that I spend most of my time and efforts of the clinical learning and development team for Ethos Veteran Health.That's what we work towards.That's an easy answer.There's the Redfield Clinical Podcast.What more do you need, Matt?Quick interruption.
I was laughing there, but I wasn't really joking.If you don't ever met in your life who is spending all of his time trying to figure out how to provide medical support to you and your team, then our clinical podcast will go a hell of a long way.In fact, I think I should stop calling it our clinical podcasts because they've become so much more than just a podcast.
Yes, I make podcasts where I interview specialists to dig into the practical details of their topics of expertise.What's new?What's actually relevant?What are we missing?What would they do in that situation?But in addition to these conversations, each episode also has beautiful show notes to back them up.
And with over 500 episodes in our playlist, we have now accumulated a textbooks worth of show notes that you can use in your everyday work for quick reference.But here's what I'm really excited about.When I say quick reference, I mean lightning quick because I've put all of those notes in an AI assistant that can instantly pull up any information from all of our clinical episodes and answer your specific case questions using the entire contents of the clinical podcast as its source of information.
Beyond that, I'm also creating other really useful AI tools to help me on the clinic floor, and I'm sharing these at no extra cost with our subscribers, like our AI Blood Gas Assistant, which uses high level knowledge to help you understand and write notes about those complicated blood gas results.
And our new baby, the Consensus Statement Checker, which has knowledge of all of the publicly available consensus statements from the last decade.So when you're faced with a decision or a discussion with a colleague where the answer isn't all that clear, you can chat to our checker to see what the experts have agreed on.
It's really fun, it's really helpful, and it is free to our subscribers.You can join our community of Vet Vault Nerds to get access to all of our clinical podcasts, all of our show notes, and our entire AI toolbox at vvn.supercast.com.That's VVN for vetvaultnetwork@supercast.com.
Oh, and if you want to talk to a real human specialist, we also have that in our specialist support space where we have specialists who can answer your tricky case questions for you.I had a really interesting scenario the other night where I had a challenging case and I went to my AI tools 1st and asked questions and I got a lot of information.
In fact, the problem was that I had a little bit of information overload.And in this particular case scenario, I still wasn't sure how to apply all this knowledge that I now had.So I hopped on the specialist support space, put a message out there, tagged the relevant specialists, and I got a detailed, very a clear cut answer back from one of our specialists saying this is what I would do in this case.
Basically, how do you apply all the knowledge that's out there in your scenario?This space is an additional subscription, but at $15.00 a month, that's Australian dollars.I don't think you'll get better value or easier access to specialists than this.I'll put a link to it in the show description for you.OK, back to Doctor Matt and the five buckets of retention.
Are you happy to talk about the five buckets for anybody who hasn't read the outcome of the study?Yeah.So I will chat about the five buckets and I will also tell you where we have the most information and where we have the least information.
I'll let you know where there's work to be done, not only by the group that I've worked hand at hand with, but I think the industry as a whole could have a lot of opportunity to work together and try to collectively fill these 5 buckets.So the short version of our studies is we ultimately identified 5 factors that explain 60% of the variance as to what would retain an ER veterinarian for a long period of time.
Should I guess they tell me to score me on why?So talking about retention in ER, why do people potentially leave ER roles?I'm going to guess that the hours will be one of the key things.The fact that it's shift work and and after hours work, I'm going to say money, but actually ER pays pretty well.
It's probably one of the reasons why people go to ER is to, to earn more.They think they're going to earn more and then culture like don't feel like they fit into the team would be high on my list.And that's where I run out of ideas.
What else?How did I?How did I go?You did great.You did great.That's one of the reasons we wanted to start filling these buckets because we found, and I'll tell you what the buckets are here in just a second.What we started to find, especially as we understood the Funk buckets better, is that there are people that through their own experiences and through empirical knowledge, they understand a couple of them and know a couple of the buckets.
And so they put all this time and energy in the buckets.And then maybe you don't grade those two buckets.But if you didn't know that there were actually 5 opportunities here, then you're just focusing on two out of the five where where if you could just have the knowledge about the five and not only what are the five And then trying to like guess as to, oh, well, I was an emergency veterinarian 15 years ago.
This has the schedule affected me and then implementing based on that, but we were able to provide new data, new information of the newest color, the newest generation here, veterans and not just the ones you're in practice now, but ones you're in school coming out what they would want, right?
And so then we meet their needs.And so I don't think realistically, if we fully implement these 5 buckets, the goal is not to get the career on from an average of three to five years in emergency practice to a lifelong career.I think that's probably a Pine Scott type of vision.
But if we can move this dial from 3:00 to 5:00 to more 8 to 12 years as a practitioner and then create other opportunities for them to be on the line so they never lose the whole ER thing that they be in it for some portions of their career, you know, like a 2/3 type scenario.
I think those are more realistic goals.And so here we go and I'll list out the five buckets and then here I'll ask you which one do you think is the most important by far away?OK, Schedule, opportunities for professional educational growth, environmental tone, atmosphere, which I would change that into culture, medical support and leadership.
So which one do you think is #1 without question, hands?So schedule is that shift work opportunity for growth Basically, are they, am I, am I, am I growing?Am I getting better at my job and culture?
Is is it a shift place to work or do I like going to work?Medical support.If I'm stuck with the cases, there's somebody I can call or somebody who's going to help me, who can help me in leadership.It says leadership just how they're running the business.Do I do I buy into what we're working towards, to the values and everything.
Is that OK?You're like.Really good at this, I can tell you.That see, I'm doing exactly what you said before is I, I'm making it about me.And for me it was schedule.I couldn't do the shifts anymore.So I I could have put up with a lot if I just had bit of sleep.
So I'm going to pick schedule as the number one thing.Leadership with that question number one thing.And in fact, in most jobs, whenever I've done this, look at other aspects of this outside profession, leadership always wins out.I think leadership drives a lot of all the other buckets really.
Like how are you leading the team?Are you leading from top down or are you really starting to lead the place of let me investigate, let me ask questions, let me be curious.Those are only like short examples of leadership.But you know, let's say I have a killer schedule that will keep you in a horrible place for a longer period of time.
So it's honestly, I believe the truth of the matter is it really requires that you identify the needs in your local hospital.We're all around these 5 buckets and you a proper legal all of these 5 buckets.It's a bit confronting as a leader.
Let's say somebody's listening to this and is in the leadership team for an emergency hospital.It's easy enough to point fingers at the other five markets and say, well, well, you know, fix the schedule.Oh yeah, the team culture's bad.And actually the most important thing is, is you, right?
It's it's you're going to influence all these things because you say culture is was one of the thing.Is it a toxic work environment?But that's leadership.It is.Leadership, that's where it comes from, usually out.Of the brain, you know, you go, I go into hospitals and I provide in in hospital consultation.
It is somewhat interesting at times when people say, oh, actually like, I love one of your stuff.Culture is horrible.I'm like, no, I think there might be something that you're pointing out like the leadership is not doing a good job.So sometimes leadership, maybe it needs to be more clearly defined of what good leadership looks like.
And some of that is making very hard decisions.Here's an example of that one.This is not to be patting myself on the back.It's long as you give me my personal experience.They're talking with employees and previous employees of ours.
We actually terminated a lot of employees and we would have this conversation with our loyal employees and our leaders within the hospital.And sometimes we knew we had to let somebody go because they weren't they were, they were toxic.I use the term toxic just because I think we'll fill in the mics what that actually means and we would have a sit down.
My partner and I would have a sit down with our higher level all forward leadership and say, hey, what?We've got two options.We both know Johnny's got to go.Do you think it'd be better if we allowed Johnny to stay until we fill that role?We don't how long that'll be, but we know that Johnny's probably bringing the place down.
Or would you prefer Johnny?We go to term and Johnny and just know that every one of us is going to have to work harder before we fill that role.Invariably they would say they wanted Johnny to go.I think part of the difference there was we would have a conversation with trusted leadership.They would be able to properly disseminate some of this information.
So it was a trust that was built throughout the hospital that that maybe you couldn't talk about all the details from an HR standpoint for all the people that had to leave.But we built trusts, and we also built an environment where they just knew when they drove up to the hospital and they knew they were going to work hard, they'd see cars in the parking lot, that they love those people.
And they would say, all right, I'm getting my game face on.Here we go.And so that's an example.Of that's I've never thought of that, but you spot on that that does happen.You drive and you subconsciously I scare the car park and I go, Oh yeah, that person's here.
That's going to be a good shift.Or, or you see?Yeah, or you see Johnny's car and you go, oh fuck, Johnny's here.It's a horrible feeling.I can almost feel like right now, I can feel that feeling like you've got to be kidding me right now.
You just want that.And so, yeah, eliminate trying to do our best to eliminate that feeling for one.So leadership is number one.And then there was not a the rest are not listed out in how important they are.They were all, as best we can tell, of equal importance.
We had the least information about medical support because your point of who can I call is a very common thought about what is medical support for an ER veterinarian really look like.But here's something to think about.What was medical support for me when I first got out of school versus middle of my career versus end of my career are not even close.
They're not close.And if the goal, we don't want all of the goals to be directed at one to three-year person.I want someone to have a thriving career as long as they want to stay.And so when I meet the needs of that 21 year veteran in ER, they're like, whoa, this is awesome.
So what does medical support look like for them?And we don't have all of that information.And I think that's one of the things.So for the audience, I would say that you may think you know medical support and you probably know some of it for sure.However, would really be beneficial is to have someone go out there and do the work, do the study, ask all of the ER veterinarians not only now but also like future.
Get down to the student level and see what they could anticipate might be medical support for them in the future.Those sorts of things can really do some kind of peer reviewed article on your findings.It's really interesting.I never thought of it that way because you're right.When you think about how do we offer support, you think about the the newbie, right?
The person who every second console is like I should.I don't know what to do Can I?We're going to ask where somebody I am that 20 something year old veteran, but I still get stumped regularly and people forget about that.In fact, it's often those people are the support for the younger ones, right?
You have the ten 5020 year old vet who is the person that everybody turns to and they might act confident because they have to, because they, the they, the one I'm the medical director.I'm not.But you know, the, the person that we're talking about might be the the team leader clinically, but who supports that person when they go?
I actually, I don't know.I don't know the answer to this.Think about a culture where the 21 year veteran, an ER, is supposed to know everything and their self worth revolves around them.Quote knowing everything and they don't because you and I both know there's a bell curve.
There's a bell curve and when you get to a certain point, you're coming down at the back end of it.What is medical support to them?A way that meets their needs and also allows them to have their sense of worth and self worth met.Because certainly we don't want to undermine that because there's so many intangibles that are personally like that brings the there are so many things that they learn that you could never teach a book, right?
So it's just an interesting process of just understanding that matter.I could speculate and I think there's a lot of opportunity there.It's really interesting.That's literally what I'm thinking about for my business.I, I had have written down the other day about where could the vet vault go?And I made a list of things that that's lacking.
We're not lacking, but needs in the vet profession and support was the second thing on my list.Is that right?I've got my clinical podcast where I teach people, but then I, we all know that you can learn until you bleed the face.And then the case comes in like, Oh, I'm struggling to apply all the stuff that I've learned or it's not following the textbook.
You know, the podcast I listened to said this, but this case is different.I'm stuck.Who do I ask?And actually having that level of who do I ask?Having somebody to bounce ideas off?Absolutely great.Well, maybe, you know, remember how we were just talking about like leadership kind of overlaps on everything else and leadership overlaps with culture and culture overlaps leadership.
I can see medical support overlapping with professional educational growth and and with that actually, especially if you get to these varying stages in your career.Really cool.Were there other findings that surprised you?Yes, let me pull up some of the data.
There are some interesting pieces to this.We'll start with a little bit of the points about the population as a whole, meaning the cohort of ER veterinarians.So this was a little interesting, probably not shocking to everybody in the veterinary profession on a whole.
If you know generate people, make that somewhere between 65 to 72%.However, in emergency practice, female gender people make up about somewhere between 80 and 82%.And it's surprising.I would have kind of thought the opposite.
But no, there you go.And I got something else for that because I kind of know where most of the guys minds where they head now.I've asked this question informally to so many people are primarily female gender people.And so this is not a steep for them.It's only to convey when I asked this question, I asked the fewer people I'm like, so why do you think that is?
Because we did not ask that in the survey.And So what I can conclude best from the majority of people is that inherently female gender people are more likely givers and they honestly want to give to the most in need.They can do the most, they can provide the most help.
So this was something interesting though, if you look at years in practice, when you look at ER practitioners that have been in practice 11 years or more, it dramatically has shifted and it's not immediate, right?
This is over time in their careers.It's 61% male, which don't jump to the normal conclusion that even all gendered people will jump to because it's not just A1 size fits.All what I mean, anything is yet kids, kids can't do it anymore.
Yeah.This is all I can say.I would say that it's not that simple.And I'll tell you, and this is once again, this time, dad, I'm about to tell you, it's more of talking about asking people that are in the field.So one thing to point out here is we're not getting some huge influx of male gendered people.
That's not why.I think we can all agree that's not why that's happening.What's happening is we're we're not making it a sustainable job for female gendered people.But remember there's a lot of people nowadays that are not having children or they're having less children.And the short version is, is female gender people typically are more likely to be givers.
And so they give to their parents, they give to their pets, they give to their clients, they give to their pet workers.They give to you keep them filling in the blanks.They give to the person on the street, they give more generally.This is all generalization, so not to be considered factual across the border or it's just generalizations because they're givers.
Think about our patient load and our client load as well.They require a lot.And if you have someone that's more of a giver than getting of themselves more, so that's going to be taking more out of them.And then let's add in like if you didn't want to have a failure, I say you're a giver or you have somebody to take care of, like your spouse who needs to be taken care of.
Or you give yourself because you're a giver and you're doing more of the household chores.All things like this to start stacking on all of the giving.It becomes untenable.And so if you create an environment where it's just a take, take, take, and then there's no give at all to the example would be OK, I can no longer do this full time.
I can do it 3/4 time.But really what you do is you leverage it in someone saying it's either full time or nothing.Like it's either full time or new benefits.That doesn't feel so good.And these horrible hours, you've kind of made it where I just can't say yes to any of this.So I think being creative and really understanding that the differences for one, we need to change what we're doing and meet the needs of our largest employee pool, which has few 100 people and asking them specifically.
So instead of like these generalizations say, OK, now what natural, what can we do to change that?And so a lot of that actually is in the study because we're talking about retention at this point, right?So that point that's a 60% variances.There's some of the things out there and they're probably very particular to geography and culture and all these kinds of things.
Someone is something that you could gather from a large group across the country that maybe works, something that you have to do at a hospital level to get the last 40%.It's a big change to consider for a, I was going to say for a leader, but not even the leader for the whole profession.
It's a big cultural shift because traditionally you'd say, well, this is the job.These are the this is the playing field.If you don't like the game, then don't play the game.And now we have to say, oh, sure, we're not going to have any players left there.The field's going to be empty.So we're going to have to change the rules.
We have to play, you know, change the structure to fit the player.And in my mind, if you think about that, well, then the people that are making the decisions should probably represent people that are in the roles.And if people that are in the the decision making roles are in think and and look like you're all they represent the people that are in the roles.
Those people that are making the decisions should not have to reimaginate themselves to fit into this other tier so they can keep that role.So what I'm saying generally, just as an example, would be if we put more female gender people in leadership roles that they don't have to be more fitting into the patriarchal society.
It should just be all equal and everyone gets to make the decisions and these decisions are going to work for these gender people is because of these gender differences or whatever it is.And that goes with regardless of whether it's gender or whatever else we decide.I think the leadership needs to really start to clearly will represent the people.
And it's not that it doesn't all the time.I think that at times there's types of improvement there and just be more aware of it is be curious.And then another thing is like the curiosity could be having more people from medicine and executive leadership roles, which is a huge, if you ever hear of businesses that do that, you should think, OK, well, that's kind of cool because not all businesses are built the same.
What so traditionally you would have not so much the the practicing veterinarians or medicine people shift into those leadership roles.You will have people who are trained in business, you know, finance.And they're staying in their lane, no cross.
But really, do you think about like even if you get down more towards the floor, hospital director, medical director, there should be overlap and understanding of both of these roles for those to work very, very, very well.If everyone just stays in their lane completely and doesn't have understand the struggles of the other portions of that.
Is that a more of a, a large corporation like a corporate type clinic problem?Because I feel like maybe that's sometimes some of the problem with leadership is in smaller businesses, invariably it is the medicine people who get shifted into leadership role roles, which is often where things fall down because we lack those corporate skills or the business skills.
So.I think regardless is if they're creating, we all know that the majority of these hospitals are now being corporate, right?So it's not.So it is important, I think to notice the differences of how the different companies are, are running and also for the companies to realize like, how could we actually retention, we go all the way back to retention.
Retention is so, so important.So as a business people, what are we going to do to try to retain?Let's do it all the way to Harvey, our veterinarians.Well, there's that out there and now there's these 5 buckets out there.I'm a business person.So how do I get there?I create an environment where I bring more medical people that understand these these issues into the executive leadership team to help guide me and then I will help guide them.
But everyone needs to be willing to take the information in and compromise in order to make a healthy workplace and laundry work environment for folks.I think that's what it walks down too.Oh, here's 1.So in going into the retention piece, the number one factor that we found actually important foster you work environment can do such and long term employment specifically for ER veterinarians, leaders recognizing the value that you bring to the practice.
Now think about that just for a second.That's the most important thing.And what does that look like?Yeah.So traditionally what, how do we measure the successful veterinarian?The only real measurements we had is basically, how many cases can you see it?
How much can you build which which doesn't?I don't know.Obviously we're moving beyond that.But I do know from social media, virtually chat groups, a lot of people feel like that's the only thing they're measured by.And there's that feeling of, but I'm so much more than that.And I don't feel like I'm recognized for what I bring, you know, my empathy, how good I am with my clients, how valued I am in the team.
I mentor the younger vets.And when I have my performance reviews, none of that's mentioned.They just go, yeah, but your billing's down for the month.Let me tell you a story, and I won't say this person's last name.This is a real story.A person's name is Rachel.And my business partner and I, you know, our goal was to provide the very best care to be the very best university veterinarians in Boulder County in the surrounding area that we possibly could focus on.
And this person was our very first employee and she was with us the entire time that we in practice And we as a business side of things, we obviously were looking at production, although they were not paid on production.
We like to just, you know, things really never be responsible, that sort of thing.Rachel was never at the top.She was never even close to the top.Rachel clearly provided so much more than the measurable dollars and we saw it.
We would talk about it.She was a part of the culture and the the family feeling the always giving more, the always willing to jump in like you can.The list is long.Like that person is like one of the not longevity, but loyal to the company.
And she was and is still like one of the best doctors of all time.But obviously it's not production.It's being a whole person and a part of what's there.And so we never once talked to her about her production.And she would come in and she would say it's time for an interview and then she wants a feedback.
We're like, you're awesome.Like we don't have any feedback because you're just amazing in all ways, shapes and form.And then she would be looking for her raise and she, we had asked her for what she thought she was worth and for the race and she would tell us and we'd always give her more and that it wasn't about the money.
It was about she never heard about that other stuff.And we could see that she was bringing so toward the practice and it added up to dollars, meaning that wasn't all there was to it.But without her being productive on the spreadsheet, she was being We were productive by the.
Which is so insightful as leaders, but a hard thing as a leader because again, it is a business and it has to make dollars.So it's very tempting to say, yes, you're great, but there's this big shortcoming and I don't know how.How do you think about that as a leader?
And on the flip side, as an employee who is faced with this problem of, well, all I ever get measured by is this, but I feel like I bring more.How do you go into that interview, into your annual review to say, I want to raise?And then they come with the numbers and they say, well, I can't justify a race because here's what you're building and you have the on the bottom end of the bell curve of how much we generate.
For for one, you can't just look at the numbers themselves without diving deep into the numbers to actually know what it means.And I think so many people, they're either being with restricted or they're knowledge restricted as to understanding how to actually interpret the numbers.
And I don't think they have a good system of identifying that.For one, let's just say that you're, and this is that's true simplification because it's, it's way more in depth than that.But let's just say that the person is bringing all these intangibles.Like the rest of the staff just loves it every day that Rachel's on staff, right?
And you, you know it because they tell you I love Richard the best.And she, she's a good person And she, you know, this is all time.It's not you don't just make these assessments early for one retention of other people is a very important factor in how healthy a business is with that question, right.I drive up AC Razor's car, but I don't want to be there now when I go into this whole concept of maybe I want to dive deeper into the numbers I need to one understand all these different details and there's this is a whole hour, hour and a half conversation how we do it.
But the short version is I really need to understand what I'm identifying in these numbers.And then maybe if I actually pursed it out, Rachel's doesn't really, there's a piece of medicine that she doesn't know.So her CDC chemistry UA's are lower than everybody else's.
And they've had a routine way of checking and seeing what the statistics were on the hospital as a whole.And it parse them out not based on how many total, but how many in percentage for how many shifts this person actually works.Like you can see you got to start down into 7010 numbers.And then I have a conversation, say Rachel, check this out like your CC and chemistries are down like, or they have been for past six months.
Would you have any idea why this is?And she's like, no, a code beats different.That's not the code I use.I use this code cuz, you know, there's like 8 different codes that people are using cuz they're in these systems and they've been in these systems for so long.And so you're not even capturing some of the information that could have indicated that maybe her production is higher.
Now I know if you're just doing global numbers, that probably won't work.But the other opportunity there is how well we talked, go back and review some of the cases together and just see like if there were opportunities and maybe we have a discussion about medicine, about money, because what I'm really looking for is for you, and I know you are too to practice.
Well, I start with we're all here for the same reason, to practice the highest year of medicine so we can provide the best cure for our patients and our clients.Everybody seems to agree with that.And then like, okay, here's an opportunity here.And as one other thing I could say is like not just being in the medical director role, but maybe if you they respected you as a clinician, maybe as an ER vet, you're ADVP diplomat.
So that also gives you some more St.Crandle the force when you're having these conversations about medicine than people that actually meet them where they are.And they say, Oh yeah, I didn't realize I should be doing that on these cases.I think a lot of it has to do with how you approach it and and not being rushed and really to be in for the right reasons and I think the right reasons well tonight would be all that were used for the very best patient.
Inquiry.Sorry, I that was a rabbit hole.It's just that you're a bottomless pit of, of information and it's such a common question that I see.So I took us on how to complete the rabbit hole there.I'm into it.Go back to those factors for retention of your veteran specifically.
Here's another one, obtaining reasonable approval for PTO.And so the short summary on that one, it's like, yes, the ordinance did sign up and they knew that.They signed up to be ER ordinance and they knew what they meant.However, it is still a sacrifice.
Nothing hurts worse like when you signed up for this job.It's like, yeah, firefighter signing for jobs, police officers signing for jobs.We seem to to hold them on a pedestal for the sacrifices that they you think about.You're veterinarians in general.I would say you're veterinarians and your staff all should be held on a pedestal because they're the ones that are getting a normal, typical lifestyle in order to be there for the ones that need the most.
They know that they're missing out.That doesn't mean that they don't miss it.OK, So what do we do with that?Well, I can tell you, let's say Rachel comes to me and she's like, I don't ask for a lot, but I need PTO because my daughter's having a recital.
Good PTO like you have to have a set plan no matter what when they need their PTO and it's something that we agreed they have PTO just.PTO paid time off, right?Is that what you paid?Time off paid.Time off and it is a done deal.There's no questions about it.It's it's not AI don't know.Let's see if we can get you off.
Not at you're off.Oh, which is massive, which is, I mean, there's a very I I work as a casual and the only reason is, well, it's because I have the podcast and I have other priorities.So I have to be able to say, sorry, can't work that shift, but I don't get paid.Then that's my decision to say, well, I'm going to take unpaid.
So being that flexible and that accommodating in in what can be really difficult to have a roster that covers is it's a big ask from a leadership team for sure.It is, however, if we look at this, if if over time you degrade the foundation of this person's loyalty because they don't feel valued and respected, and then you lose your veteran because you're just tired of it.
So they did.Yeah.Then get in the goods because the year that's already, you know, all they're asking is for their time off.Guess what happens on the 95 job.I'm going to be off on Friday.See you later, gentlemen.Nobody's nobody's saying.Let's see, come get you off on that one.You see what I mean?
They get it off.You know why?Because it really does their their job's not quote life or death, but but that's not something you won't hang over their heads.You say, you know what you suffer.And this is all about this opinion, just so you know.But the the reality of it is like you pay extra, get somebody out and it's qualified to take the job, but you're going to win in the long term.
So it's a little hit up front.Most of the time you've done well, it's probably not hit at all.But occasionally you're just going to have to take a hit eventually because you want the person you go from three years to 15 years in your hospital.That's massive because when we talk about schedule bucket number one, we focus on the the nature of the shift work and the lack of sleep and stuff.
But the other thing is exactly that is that lack of flexibility and lack of autonomy and feeling.Well, I am, I'm locked in for that shift six weeks from now and now somebody's invited me to their hands do or something.I can't go because I'm locked into that shift.And once, once they're asked to set, it's my responsibility to change.
And I've got to phone 10 people to ask can you change?And it's a pain in the ass and then you just go, oh fuck it.I'll just sacrifice my private life so that I can fulfil my duty because it's life and death.Talk about burnout.There it is.Full, full front facing burnout.
So then the next thing is there's obtaining help when requested.And so I just wouldn't emphasize when requested because it doesn't feel good when people like jumping in to help you and you're like, hey, I don't really need your help.Just kind of being management case that kind of feeling.
So when requests should be done blind, an environment where a positive attitude is a high priority, we're still going through the some of the more the higher ranking factors for retention of year over year.And so an environment reposit attitude is a high priority sense culture being able to provide help we requested.
So think about that one for a second.So really what this is nuanced about is think about how people are paid and especially think now.So we're out of like the code craziness and too many cases to see.Now we're down into, OK, well, caseloads might be down here at times being able to help, provide help when requested.
So if I've created an environment where my more seasoned, more knowledgeable veterinarians cannot stop seeing cases and mentor these younger people, then what happens?The younger people don't get mentored and these other people feel bad, moral injury, moral stress, because they really want to be able to help.
But they're sitting there going, well, if I do this and spend an hour with this person behind not seeing those cases going to pay cut.So don't create that environment because everybody loses.Everybody loses with that.Being able to provide help.
We talked about that one.And then having rounds be a pleasant experience.A lot of that has to do with the rounds and these sticky yards.So coming off a 14 hour shift and you want to you want to provide me a teaching moment?Yeah, let's not do that.
How about we do that teaching moment when I'm back here at six, I'll be back in six with my coffee and I'm all fresh.And then when you, because I will tell you this, if it was critical, nobody would be at rounds.We would all be mid side, you keep side, we'd be dealing with what was critical.So it's really not that critical that we, we kind of take this knowledge to give a teaching moment.
And there's a lot of other reasons that rounds cannot be a puzzle experience.I mean, their list is actually very long.That's like easy loading fruit.But one of the things I do is to help to identify our rounds of pleasant experience in your hospital.And if they are not, let's identify what prudence we can do.
And there are a lot of different reasons and they'll be shocking to you at times as to the wise.So we have not talked about.So we've talked about leadership, we've talked about culture, which is environmental atmosphere.In regards to medical support, we touched on that and we touched on that.
We really don't have a ton of information here that's anything other than our opinions.The schedule was one thing I pointed out and then the last piece, and this is not the last piece because this is the most important piece.It's an important piece.And I would just advise everyone, none of these individually are panacea to solve an issue, right?
But there's professional educational growth and what does that mean and what does it look like?And it is also multi layered.One of the things I like to think about is like, well, we're, I'm trying to create thriving careers for emergency practitioners.And the way I think that I do that with the help of, of the people that work with me is to create opportunity.
Feeling stuck is a common feeling for ER veterinarians.Is this it?Is this what my life is?What is my skill, real skill of practice, especially, I mean, these different specialty hospitals, like do I get to do any of the cool stuff or you know, I feel like I've done this a lot.
So what's next for me?And that to me is professional education growth, but real professional education growth, meaningful, valuable professional education work.So one thing is it has to, when you do it, it has to hold value to the person that's doing it.
So what does it ultimately mean and what is the value?And so a lot of the work that I do is around creating board certified general.One of the biggest reasons for, well, there's a couple of big reasons about creating board certified gymnasts for one year.
Veterinarians are like, well, why would it be from a board certified gymnast?Well, think about just go in your mind's eye right now.I'm going to ask you, Hugh, as an emergency practitioner, name the top.So it takes a time, but what types of cases and maybe what discipline?
Even if there is a specialty for it, we're not.What are the top four types of cases you see on the ER?Gastrointestinal disease #1. 100%.GI disease I, which is when people ask me what's it like working in emergency, I always I'm a bit cynical, but I say, I always say I hope you like diarrhea.
It's always GI.And you can be more general too after that if you want.Yeah, it's AGI.Look, it's most mostly I again, I generally say to people it's GP practice in the dark.
That's that's what emergency is we and then we get sent the more critical cases where people say, OK, well, this is beyond me and that, but that's a 5% minority, maybe 10% of the Super sick ones, right.And then the actual emergency cases also, everybody gets super excited about a real, you know, the trauma case where I live in, in Queensland, we probably see a higher percentage than many other places of snake bite.
We have a paralysis tick, those sort of things.That's a significant proportion, but it's very highly geographical.I used to work on the West Coast of Australia where way less of that stuff, lots of skin, skin and ears.You get like it's it's 1130, people can't sleep because the dog's got a painful ear and they're emergency for skin.
So you got it.You have to be a good generalist for sure.So GI, internal medicine, surgery, we do ophthalmology, urology, cardiology, toxicology, all the infectious diseases, dermatology, like critical care, but you list it and we have to know it.
We have to know it quickly.We had to create trust rule rapidly.So now let's say that we can take you for where you are and make you a board certified level practitioner with that same information.Doesn't that sound appealing?
And then what Board certified specialist ABMA recognize board certified generals?Now, if I told you I could do that without you for one minute being in a residency, would that be more appealing to you?Sorry, but that's the thing.
It's because what you said, that stuck feeling, we all feel it.I've.That's.Why?That's why I started a podcast because I was stuck and everybody does.But the the problem is, and I think about this so often because that next step of saying, OK, well, let's let me specialize.
It's a massive, it's a massive commitment in terms of time and money and energy, sacrificing relationships, children and everything.So that's why most of us don't do it, because you go like practically I can't do it.We all know they're all residencies are not created equal to.
Don't we all of us know this.I know plenty of people that have gone through residency and there was no mentorship.There's no didactic training at all.They did oh, self-directed learning.And I'm not saying that that's what residencies are.
I know, I know for a fact that I know many people read on through that type of residency.So really when you get to that block, but they're they're four served on specialists.They did it on their own.They did the horrible hours of horrible pay and they had to because that was the only option.
Doesn't mean that they're not great.They are great.And we can all we probably even there's people that write all textbooks that have to go through that same process.But I don't think one makes it right.So I'm glad you're going with me here for a little bit.So did you know that the ADMA does not require that person go through a residency to become a specialist in anything?
Did you know that at this point in the conversation, me and Matt went down a completely different path that has nothing to do with recruitment and retention?So I'm going to leave you here with that mic drop moment, but I will release that conversation about alternative pathways to specialisation as a separate episode.
We'll see you back here for that soon, but for now, thanks for listening.Before you disappear, I wanted to tell you about my weekly newsletter.I speak to so many interesting people and learn so many new things while making the clinical podcast.
So I thought I'd create a little summary each week of the stuff that stood out for me.We call it the Vet Vault 321 and it consists of three clinical pearls.These are three things that I've taken away from making the clinical podcast episodes.My light bulb moments.Two other things.These could be quotes, links, movies, books, a podcast highlight, maybe even from our own podcast.
Anything that I've come across outside of clinical vetting that I think that you might find interesting.And then one thing to think about, which is usually something that I'm pondering this week and that I'd like you to ponder with me.If you'd like to get these in your inbox each week, then follow the newsletter link in the show description wherever you're listening.
It's free and I'd like to think it's useful.OK, we'll see you next time.

Dr Matt Booth