May 14, 2025

#142: Thinking About Telemedicine? Here’s What Veterinarians Need to Know. With Dr Shadi Ireifej

#142: Thinking About Telemedicine? Here’s What Veterinarians Need to Know. With Dr Shadi Ireifej

In this episode answer all your questions about veterinary telemedicine with Dr. Shadi Ireifej, board-certified surgeon and co-founder of VetTriage, a global tele-triage platform. The discussion addresses both veterinary professionals curious about a career in telehealth and practice owners considering telemedicine integration.
The conversation addresses common concerns, like fear of inadequate knowledge, potential legal risks, and the assumption that telemedicine could be unfulfilling or monotonous. Dr. Ireifej gives insights into who a career in telemedicine would appeal to, and why the model allows for part-time work alongside brick-and-mortar practice, providing a balance that can help retain staff.
For practice owners, Dr. Ireifej highlights telemedicine's potential as a powerful recruitment and retention tool, with many young vets valuing the flexibility it offers. He also explores future trends, including telediagnostics and emerging technologies like thermal imaging monitoring systems, which are already transforming patient care. The episode wraps with a realistic overview of the challenges and lessons learned in building a telemedicine platform, such as the need for reliable technology and consistent medical record-keeping.

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Season 1

Telemedicine.

What’s your gut reaction when you hear that term?Maybe you think it was just a clever COVID workaround, or second-rate substitute for a “real” vet visit.

Or maybe you’re a bit curious about what it’s like to work in telemedicine— but you’re worried it’ll be boring. Or worse: that you’ll spend your days diagnosing lizards over Zoom.

Whatever you think— chances are, you’re wrong. But don’t worry. This episode will change that. We go deep on the real-world pros and cons of telemedicine , from two key angles:

For curious vets:

    • What’s it really like to work in telemedicine?
    • Is it fulfilling?
    • How will I cope with all the tricky questions (and species?!)
    • Is the pay good?
    • Can you get into trouble for giving remote advice?

 

For clinic owners:

  • How do you integrate telemedicine into your practice?
  • What are the practical hurdles?
  • What’s worked (and what hasn’t) from someone who’s built a global platform from scratch?

 

Our guest is Dr. Shadi Ireifej , a board-certified surgeon, tech entrepreneur, and co-founder of VetTriage, a global teletriage platform.

This one made me rethink what “good vet work” really means. I think it’ll do the same for you.

 

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Topics and Time Stamps

01:43 So you think you want to work in telemedicine?

04:20 Common concerns about telehealth work

06:11 Will I get sued for giving the wrong advice?

10:37  Vets on Tour: Upcoming Events

15:55  Income and Work Hours in Telemedicine

18:35 Will I have to give advice for all sorts of weird animals?21:29 Unexpected Joys of Telehealth

23:44  Future of Telehealth and Technology

29:21  Challenges and Lessons in Telehealth for Practice Owners

36:33 What about the technology?

What It’s Really Like to Work in Veterinary Telemedicine

Working in veterinary telemedicine, particularly in a tele-triage setting like Vet Triage, offers a unique experience with specific challenges and rewards.
Here is what it's really like to work in this field:
  • The Nature of the Work:
    • As a "tele vet," you engage in veterinary consultations remotely, often via video calls.
    • The cases are typically routine general practice situations, such as skin issues or diarrhea.
    • The primary goal is often triage: determining if an animal has an emergency and providing advice or direction until they can see their family veterinarian. This might include palliative care instructions or what clinical signs to look out for.
    • You might deal with a wide variety of animal types, from dogs and cats (which make up over 90% of cases) to a wide variety of more unusual animals.
    • While you don't perform physical exams or diagnostics like palpation, radiography, or lab tests, you rely on basic principles and your experience.
  • Common Concerns and Challenges:
    • Fear of giving wrong advice and legal liability: This is a common and understandable concern among veterinarians considering this work. There is a worry that advising a client that a situation is not an emergency could lead to a negative outcome for the animal. However, the risk of liability in telehealth appears significantly lower than in brick-and-mortar practice, statistically speaking. Platforms like Vet Triage implement multiple layers of protection, including website information, disclaimers clients must sign, the doctor reiterating limitations, written records with legal language, and providing clients with tools to monitor the patient and recontact the service.
    • Dealing with unfamiliar animal types: Veterinarians may worry about having to give advice for species they have no clinical experience with. While this can happen, the approach is often based on basic triage principles, and you are not expected to have all the answers immediately. You can research information or consult with colleagues and call the client back.
    • Boredom or feeling unfulfilled: Some veterinarians transitioning from clinical practice worry they might be bored or unfulfilled due to the lack of hands-on procedures or critical cases like CPR or surgery.
  • Unexpected Joys and Rewards:
    • Giving clients peace of mind: A significant source of enjoyment for tele vets is seeing the relief and stress reduction in clients when they are told their animal's situation is not an emergency. This is highlighted as a primary reason why vets enjoy the work.
    • Helping in difficult situations: Even when a situation is severe, providing advice and perspective can help owners and potentially keep an animal alive until they can reach a veterinarian, which vets find rewarding.
    • It can feel addictive: Some seasoned tele vets describe the work as having an "addictive" quality, viewing it akin to a "veterinary video game".
    • Flexibility in work arrangements: Telemedicine work can be done full-time (40-60 hours a week) or on the side in addition to a brick-and-mortar job. This flexibility can contribute to a happier veterinary career by offering a change of pace or environment.
  • Suitability and Experience:
    • Experience is crucial: Most platforms require a minimum level of real-life experience, with Vet Triage typically hiring veterinarians who have been out of school for at least five years. Newer graduates may struggle with feeling comfortable giving advice over video without sufficient practical experience.
    • Personality matters: You must enjoy talking to people. If you prefer getting your hands dirty with surgery or procedures and dislike client contact, this job is likely not for you.
    • Comfort with spontaneity: You need to be okay with not knowing what type of animal or case will appear on the video call without warning.
    • Collaboration: There is often a collaborative environment where veterinarians can talk to each other and share ideas and experiences with different species and situations.
  • Income and Work Hours:
    • Compensation models vary by company. At Vet Triage, veterinarians are paid per call or video consultation seen. Calls average 10-12 minutes, allowing vets to handle 4-6 cases per hour.
    • Income depends on the volume of cases seen, which can be inconsistent.
    • There can often be a mal-distribution of cases, with the busiest times often being evenings and weekends/holidays (in the US time zone). This means veterinarians need to be available during these hours to make the most money. The middle of the night is typically quieter.
  • Technology and Operations:
    • Telemedicine requires a stable and secure platform. While practices could use off-the-shelf tools like Zoom or WhatsApp, they may face challenges with technology issues on the client's end (bad internet, older devices, lack of tech savvy).
    • Developing a robust, custom platform that is web-based, device-agnostic, secure, and allows for evolution as rules change (like requiring electronic medical records) is an significant undertaking.
    • Maintaining tight and thorough medical records is crucial, perhaps even more so than in brick-and-mortar, due to the limitations of virtual interaction. Consistency in record-keeping among multiple doctors can be a challenge.
  • The Future:
    • Telemedicine is expected to continue evolving, incorporating technologies like telerobotics, telediagnostics, telementorship, and telemonitoring. Telediagnostics, such as devices using thermal imagery to monitor parameters like temperature and heart rate remotely without physical contact, are already emerging. Augmented and virtual reality may also play a role in the coming years.
Overall, working in veterinary telemedicine requires a specific skill set and personality type focused on communication, rapid assessment, and comfort with a range of cases and technologies, offering a different kind of fulfillment compared to traditional clinical practice. It provides flexibility and the opportunity to help clients in new ways, addressing concerns they may have about emergencies, cost, or accessibility.

 

The Pros and Cons of Integrating Telemedicine into a Practice

Based on the sources, integrating telemedicine into a veterinary practice offers potential benefits but also presents significant challenges, particularly regarding the veterinary culture's adoption and technological hurdles.
Here are some of the pros and cons:
Pros of Integrating Telemedicine into a Practice:
  • Working with Existing Clients: Practices can incorporate telemedicine for their own clients, where an established Veterinary-Client-Patient Relationship (VCPR) already exists.
  • Staff Recruitment and Retention: Using a tele-triage service, like Vet Triage, to handle after-hours calls can significantly reduce the burden of on-call duties for practice veterinarians. This is highlighted as a particularly attractive feature for new graduates who often wish to avoid being on call. Reducing or outsourcing on-call duties can help entice vets to join a practice and can help with turnover.
  • Improved Work-Life Balance and Flexibility: Integrating telemedicine can allow staff to work from home for certain appointments, offering a change of pace or environment. This can enable vets who cannot be physically present in the clinic (e.g., due to pregnancy) to continue working.
  • Increased Capacity/Productivity: If many appointments become virtual, a practice could potentially quadruple its appointment capacity.
  • Future Technological Advancements: The integration of future technologies like telediagnostics (e.g., devices using thermal imagery to monitor patient parameters remotely without physical contact) could offer new ways to manage patient care within a practice setting.
Cons/Challenges of Integrating Telemedicine into a Practice:
  • Resistance from Veterinary Culture: It has been difficult to convince the broader veterinary culture that telehealth is a viable method of practice. Vets can be skeptical, resistant to change, worried about ethics, providing "bad medicine," and potential impacts on income. This resistance is particularly strong among large animal and equine vets who are traditionally used to being on call 24/7 and having clients contact them directly.
  • Low Adoption of Integration Models: Despite the potential benefits, models involving leasing telehealth platforms for use within brick-and-mortar practices or using off-the-shelf tools (like Zoom or WhatsApp) for client consults haven't widely taken off as expected. It quickly ran out of steam.
  • Perceived Lack of Value: Some employers in brick-and-mortar settings may not see the value in paying a veterinarian a six-figure salary to work from home via video calls.
  • Technological Hurdles: Clients often present challenges with technology, such as bad internet connections, older devices, lack of tech savviness, or devices dying. This makes setting up and conducting virtual consultations reliably challenging and often requires dedicated technical support teams.
  • Maintaining Consistent Medical Records: Just like in traditional practice, ensuring all doctors maintain tight and thorough medical records can be difficult, but it is especially crucial in telemedicine due to the limitations of virtual interaction.
  • Veterinarians' Preference for Hands-On Work: Vets working in a hospital setting may prefer to perform physical exams and diagnostics. They might feel inefficient or wonder "what am I doing here?" if they are stuck on a video call when they could have the client come in for a hands-on appointment.
  • Platform Development Costs and Complexity: Building a custom, secure, and evolving platform suitable for telemedicine is a significant undertaking requiring substantial investment and development resources. While off-the-shelf tools exist, they may lack necessary features like robust security or the ability to adapt to changing regulations.

 

We love to hear from you. If you have a question for us or you’d like to give us some feedback please get in touch via our contact form at ⁠thevetvault.com⁠ , or catch up with us on ⁠Instagram⁠ . And if you like what you hear, please share the love by clicking on the share button wherever you’re listening and sending a link to someone who you think should hear this.

When I say the word telemedicine, what's your first thought?Your gut reaction?Maybe you think it was just an interesting COVID experiment, or a stopgap for clients until they can get to a real vet.Or maybe you're curious about what it would be like to work in telemedicine, but you're worried that you'll be bored or that you'll just end up diagnosing lizards on Zoom.
Whatever you think, you're probably wrong, but don't worry, this episode will set you straight and answer all of your questions you've ever had about telemedicine.I'm Ebert Hemstra and you are listening to The Vet Vault where we explore these spaces beyond the consulate room and shine a light on what's possible in modern vetly careers.
Our guest today is Doctor Shady Erefish, a board certified surgeon, tech entrepreneur and Co founder of Vet Triage, a global Tele triage platform.In this conversation, we go deep into the real world pros and cons of telemedicine.We take A2 pronged approach, one from the perspective of someone who's curious about what it's like to work as a vet in telemedicine.
And we answer questions like what is working as a Tele vet like?Is it satisfying?Will I get paid well?Will I get in?Trouble for giving the wrong advice?And if you're a clinic owner thinking about integrating telemedicine into your business, there's gold in here for you too, as Shady gives us his behind the scenes insights into the practicalities, the challenges and the lessons learnt from his years of both creating and working in his tailor triage business.
Personally, this is one of those chats that really made me reflect about how we define what good vet work looks like, and I think you will too.Let's get into it with Doctor Shady Erefich.So I want to consider a career in telemedicine, but I have some questions.
I want to know what it's like to work as one.What are the what's going to irritate me?What's great about it?Things like that.You have a team of how many, how many people do this?Just over 70 doctors and then we have half a dozen support staff, most of which are veterinary technicians, veterinary nurses.
They answer the phones, they don't get medical advice, but but at the face of the public, about 70 doctors.Here's a question.When?Well, now maybe as well, but in the early days, did you actually need to get on the phone and speak to clients as the doctor in the team of the ownership team?
Did you have to do the actual work?Yeah, in.The in the beginning, when we first launched this, I was the only doctor on the platform and we were global from from day one and any animal type from day one.So I was doing all the calls.I still jump in once in a while because I don't want clients to wait too long and so I'll jump in and help my veterinarians out.
OK, so you are out there on the frontline sometimes.So you, you if when I ask these questions, you you can definitely give me first hand experience.I do wanna make surgeon jokes is your general advice when somebody calls you like, yeah, Mr. Cut, cut it.Yeah.How do you handle the questions about the deworming protocols and parasites and stuff like that from way back into university?
I'd imagine with in your residency and surgery life, you didn't deal with too many first opinion.Oh.For sure.And just like I didn't, I have never worked on horses or cows or sheep and yet we would get these calls about a kangaroo or an ostrich or a squirrel.And I have no clinical experience with that.
But if there's one thing that veterinarians are good at, it's being versatile.And so if I know that the question being posed to me by the pet owner is not an emergency, but I don't know the answer, but I know it's not an emergency, I can tell the client, look, let me do some research, talk to my colleagues and I'll call you back later with some information.
And then they appreciate that because they at least they know it's not an emergency and I can now contact them back and give them a more well informed decision.If it's a really weird animal type, I will literally look up material with the pet owner watching me looking at Merck Manual or I'm doing a pub Med search to find information because sometimes that pet owner owns a really weird animal.
They know more than I do about it, and so they just want a doctor's perspective on it.So I have to educate myself.I think we've just addressed probably one of the big worries for somebody considering this is that fear of going, am I going to be able to do this job?Am I going to be able to perform on the spot and make the right decisions and, and not give bad advice?
So that's actually a great answer because is that something that people worry about when when you have interviews or when people contact you about work?Because veterinarians are reliant on their hands, they want to be able to perform a physical exam on their own.They want to perform a rectal exam, listen to the heart and lungs, they want to run blood work and radiographs and all that stuff, but they want to have medical records in front of them and so they are concerned.
However, I have found that the cut off time from graduation to when I will even entertain the idea of them during the team is five years.Most any vet that I've tried to hire who have been out for under five years from school, they just, they get killed on this.
So you have to have some level of real life experience.You have to have seen a case 1000 times in order to feel comfortable giving a pet owner advice over video.So yes, you're absolutely right.Even a seasoned veterinarian is scared of it.But when they get into it, they realized quickly these are very basic situations and these pet owners just need Peace of Mind of what to do, what to do next or what to look out for.
But yeah, there is that fear.But you have to have ample clinical experience before you can dive into this.But also don't forget, you know, Hugh, that we started this, this platform from day one being global, any animal type.You don't have to do that if if you if you want to just dogs and cats.
I'm sure there are platforms out there that just new dogs and cats.If you want to incorporate telehealth in your brick and mortar practice.That way it's your own clients, you know them, you already have an established VCPR.You can do that.So you don't have to do what we're doing.We did this because the long term plan is to partner with veterinary hospitals, university shelters, rescues, etcetera, and be the all-encompassing tool that they can rely on to help with their case management.
We're unique in that no one else does it this way, but it's also daunting.Yeah.So that's one concern addressed.Do you have other things that pop up when people start speaking to you about it and going well?I'm interested.Common concerns, fears, worries that need address that you see popping up.
Absolutely.So the legal aspect, they're worried that what if I tell a client it's not an emergency, you can wait for your vet to open and then the dog dies overnight.It's a very common concern and rightfully so.On our platform, I've created several layers of protection.
The first layer of protection is going to be the website.The website says specifically what the client should expect, triage and advice.Then the second stage is before the client, after they create an account, before they pay, there's a disclaimer.They have to read the disclaimer and sign off that.
They acknowledge the disclaimer, and the disclaimer talks about BCPR and the pros and cons of telehealth.After that, we have our doctor.They are the third layer of protection.The doctor reiterates what the goal of the platform is, what they feel comfortable doing, what they can say, what they can do.The fourth layer of protection is the paperwork because we emailed the client the medical records, which is a summary of the advice given and at the bottom we have more legal language that reminds them of the disclaimer they sign that we are limited by what we can do, it's virtual, etc.
The the next layer of protection is we give the client the tools they need to monitor that patient.So what clinical science look out for and then we also give them the means to re contact us without paying again by e-mail or phone 24/7.These things are monitored and that way if the pet does decline or show additional symptoms, they just have more questions.
They can talk to a veterinarian free of charge 24/7 until their veterinary clinic is open again and then we hand them off and knock on wood.So far we've been, we've been safe.We're approaching 200,000 cases in under 5 1/2 years and we haven't had a problem yet.
So all of these layers protect us and it's it's worked well so far.So how I read that answer is a yeah, it is.It is potentially a concern, hence all the protection.So if you are considering a job like this, double check that where you're going to work, that you are protected to some extent, that there's something to to to cover your ass if it should happen, but also be the reassurance of you guys have the numbers to show.
Yeah, theoretically possible.But if you're an experienced vet, it's and you know, if I think about, because that's definitely one of my concerns and I still feel the same when I'm on shift in an emergency hospital and people will ask for advice often, very often I'll answer a question going, yeah, that sounds fine.
It doesn't sound like we.And in the back of my head, there'll be a little bit of what if you're around, we're going to say.But that's, that's human nature, right?Like we don't like, we're not, we're not gods.We can't predict the future with 100% certainty.Any reasonable human being knows that you're doing the best you can with what the tools you've got ahead, ahead of you and also what your experience levels are.
But also, if you look at the numbers, the number of telehealth cases that have been brought to any medical board globally, for all intents and purposes, basically zero.But if you look at any given area, a county in a state here in the US and look at the number of medical board complaints that occur, it's going to be probably hundreds, if not thousands.
And if you multiply that by an entire country, I mean, it it, telehealth doesn't even touch the numbers that brick and mortar has.So just by virtue of statistics, brick and mortar has way more risk of liability than a virtual platform.I mean, that's interesting.
I wonder why is that you think it's expectations?Is it because the client will set will appreciate the limitations as to what you can say and do?If I had hypothesized the different reasons, I think that's one of them.I think clients have common sense.They understand you're doing the best you can over a virtual medium.
There's also the fact that telehealth compared to brick and mortar is still fairly new, and so maybe it just needs more time to get more errors happening.The third also is that in a brick and mortar setting, as you know, whether you practice ER or general practice or specialty, you have 1000 things going on in your mind.People are waiting, animals are coming in critical, all this.
You're trying to discharge patients, you want to get your staff to leave on time, medical records.And so you're going to be prone to making errors.You have all these things in your head you're trying to juggle.So there's many factors and I'm sure there are way more that we haven't thought of that contribute to those numbers.But I also want veterinarians to understand if they want to be a Tele veterinarian, that speaking based on numbers and our experience, the risk is very low that you're going to run into a problem, OK.
I want to give you a quick update on what's happening with Vets on Tour, our destination Snow conference in New Zealand from 10 to 15th August.We have finalized our academic program and I think we've put together something really special.We're focusing on GI disease, ophthalmology and FIV&FELVFELV.
We are importing Doctor Catherine Bush all the way from Germany to delight us with her favorite topic, diarrhea, acute chronic hemorrhagic, the whole smelly, a lot of it, with a particular focus on the microbiome and how and when we can use fecal transplants to manipulate it and improve diarrhea.
Ophthalmologist Dr. Matt and Neil will get us up to speed on the emergency eye and GP level ophthalmology surgery, while microbiologist Doctor Mark Westman is going to clarify all of the myths and misunderstandings about feline leukemia and FIV.We've also booked a band.
We're buying our ski passes and everything is shaping up for an epic week of CPD and adventure.And with only 16 tickets left, it is time for you to get off the fence and just bloody commit.But if you can't make it to New Zealand, or even if you can but you just can't get enough of snow and CPD, we have some early news about our next 2026 event.
We've locked in a venue and speakers for Japan 2026.On the 23rd of Feb we will be going to Nozawa Ansun.If you've never heard of Nozawa Ansun, think traditional Japanese mountain snow village Hot Springs saki served on a tray of actual snow monkeys in natural hot tubs and that famous Japanese powder.
If you'd like us to e-mail you when we go live with our pre sale tickets for Japan, shoot me an e-mail at info@thevetvo.com so you get first pick of our best pricing.Oh, and for our US listeners, I googled it.It's just a 12 hour flight, so no excuses.We want to see you there.OK, back to Doctor Shetty and telemedicine.
All right, other concerns, I'll.I'll give you one of mine.If I am a clinical veterinarian and I'm considering switching, I worry about that.I'd be suppose bored or unfulfilled or, you know, I'm just going to be going.Yeah.All right.
Yeah.Your dog's itching.Go to a vet.Is is that a consent?And and how do you find the people who work in it?So in in interviewing my vets who are the most seasoned, meaning they've been with me since almost day one.So years now, a lot of them will describe this as being having almost an addictive type of like hook to it where it's kind of like downloading the game on your phone and you're just hooked on it.
They view it as a veterinary video game.They find it fun, even though the cases might be a skin case or it's a diarrhea case, you know, pretty routine, general practice stuff.There's no, there's no CPR, There's no tapping an abdomen or a chest.There's a, there's an addictive thing to it.
They enjoy it.I think a key thing to you, honestly with this is you have to love talking to people.If you're a veterinarian who loves animals, but you kind of don't let the communication part of it, you might find this a bit stressful.But if you love speaking to people like I know you do, I definitely do you.
It's enjoyable because you're just, you're seeing the relief of people.The stress leaves their bodies as you tell them it's not an emergency.Don't worry.Here's what we can do.Here's what we can monitor for.Call your vet in the morning.I'll send you the paperwork.I'll send them paperwork.They love it.They're like, Oh my God.And that's what gets me high off of doing this, these sessions.
So I don't think the veterinarians get bored of it.And most of my vets are either from general practice world or from the emergency world.And so two different mindsets in terms of like how urgent things are in their day-to-day and they seem to enjoy it.
But to be fair, like I said, it's not for everybody based on your personality type or what kind of hours you want to work or all that.It's not for everybody.I've had plenty of vets that have come and gone and that's fine.It's it.It has to resonate with you in order to be fun.Yeah.
All right.So maybe it is.And I suppose it's like any job, I was going to say in the vet profession, but any job at all, pick the job that suits your personality style and your likes and dislikes.So we've got two kinds of people.It's maybe not for have some experience under your belt.So not, not too inexperienced #2 if you're, if you like getting your hands dirty, if you're the I want to cut stuff and do stuff, then obviously this is not for you.
And yet, as you, as you say, there are many vets I know who hate the client contact.But this is not your job.This is not your role.Are there other things that you would say?OK, the the people we've employed who are like this or or prefer these things, they don't last.They bail.Other exclusion I have one more thing to to, to the last statement.
You don't have to do this full time, right?You could work with a very busy crazy brick and mortar and then you do that triage or some other platform and it's much more low key and relaxed and slower pace.So you don't have to go all in.You know, I do have 1/3 of my vets do this full time, meaning 40 to 60 hours a week.
The other two thirds don't.They do this on the side and they have a primary job in brick and mortar.Actually a really good point.I, I'm a very strong proponent of people who say I don't like being a vet.My first question is always, Are you sure it's not just I don't like being a vet 50 hours a week and, and finding ways to say, well, let me do a little bit of that.
And then something else that's a change of pace or a complete different environment is for many people.I find that that's the key to the happy vet career and realistically a lot of people will do this as an additional or a different source of income.And again, this is obviously very specific to each daily triage company, but as a general.
Rule.Is income comparable between this?Because I look at it from a business owner's perspective saying, well, if I pay a vet at an hourly rate and in their time there, they might do a massive surgery or something, that's going to bring in a lot of money for me from the business with you guys, it's consult fees only.
You're not selling anything else.So is it similar sort of income or less or like what can they expect?Yeah.So I can't speak for other platforms because they all compensate their veterinarians differently on hours at least right now.It could change in the future, but the veterinarians get paid per call that they see or video that they see.
And on average, we know that at least on the non equine platform, the average calls maybe 11:50 minutes.And so if they get paid X number of dollars for the one call and it takes them 10 minutes on average and they get fit 4 to 6 cases an hour, then they can do the math per hour, per week, per month.
And is that worth it for them or not?The other factor to that too is what hours do you want to work?Because even though we're a global company, we still see a Mal distribution of cases.We still are very busy between and again, I'm in the US so between evening time on any given weekday till about middle of the night, it's our busiest.
The rest of the time is quieter.And then weekends and holidays of course are very, very busy.But the middle of the night is typically quiet.And and that's despite seeing clients from Australia, New Zealand or Hawaii.It seems to be that that that distribution is consistent year by year.So the question is, depending on where you live, are those hours that you want to work because that's when you're going to see the most cases that make the most money.
The final thing that I'll mention is the lack of consistency.I can't promise you how many cases will come in any given hour because just like an emergency hospital where you can have an oddly quiet Saturday and an oddly busy Wednesday morning, it's the same thing for us too.
These are not appointments.These are all walk-ins.And so you can have a Saturday night that's just really quiet and then a Monday morning that's like, what?What the Hell's going on?It's so busy, right?So we rely on our data of over five years where we know on average we are busiest these days and these times.
So if you're a veterinarian who needs more consistency with that, this may not be the one for you.If you're a veterinarian who is fine, you want fast action, get things going and when it's quiet you're OK with that, then great.You know that that's for you.So that's how we operate currently.I know other platforms operate differently.
I just don't know their their details, but that's how that's how we we compensate the.That makes sense.And like one more concern that veterinarians have on the platform.So seeing different animal types, right?Because not every veterinarian is comfortable with not knowing what animal type is going to show up on our platform.
If you remember name, phone number, e-mail, that's it.The video pops up and it could be a dog, a cat, a chinchilla, a snake.You don't know.And I tell vets at the interview, not every vets nervous system is made for that.So you have to be OK with the fact that a chicken can show up on the video without any warning.
And the client is like, do you know chickens?And they're holding their chicken on the camera, That happens.And so again, that's not for every veterinarian either.You have to be OK with that, with that sort of spontaneity on the platform.Even though we know over 90% of our cases are going to be dogs and cats, still you're we after dogs and cats.
It's rabbits, birds, reptiles as most common.And they have to be OK with that too.So that's another aspect of this that may concern some veterinarians.Yeah, that would be a something that I'd have to think about carefully, personally.You're right.I, I do like to know what I'm heading into and I like to feel like I know my stuff.
But you said before, the goal is not always a resolution of the problem, right?It is very often based on basic principles.I think you can wait and go see an exotic specialist in the morning.In the meantime, try this and this and this and this.It's not necessarily.
Oh, yeah.Your parrot has a nutritional deficiency.It needs to be on this meeting.Yeah, the the first step is triage.Do you have an emergency or not?If you do, let's see if there's some emergency options.If you don't have an emergency or you do have an emergency, but there's no emergency options, What palliative care, what advice, what instruction, direction can I give you until you can see your family veterinarian?
In the case of exotics, even during the weekdays daytime hours, they still can't find a vet.And so they might you might be watching a a distant Guinea pig.Take on camera that probably has bronchial pneumonia.It needs to go into a hospital.
Right now there is no option because of where they live.There's no exotic vets or whatever.So even in those situations we are, we have the, the responsibility of trying to give them some advice of what to do, what to look out for.So it it, we get pretty creative and that's where collaboration kicks in.
Our veterinarians all talk to each other and they all share ideas because they all have different experiences with different situations, different species.So it's a great collaborative environment for that purpose.OK.So, so you're also not and again, I'm trying to make this as broadly applicable as possible and not just your service, but for you guys, you're not on your own.
If you the on the vet you can ask correct.Absolutely you can do, you can do research with whatever items you want to do research with, whether it's online or textbooks or whatever.You can talk to our colleagues.You can talk to your own friends, your own colleagues on your own personal life, whatever it may be.
And then contact the client back later and tell them what you think after you've done your research.So that's that's fine too, of course.Are they sort of unanticipated picks, joys, things that people really enjoy about this that you might not think about?One, one that I alluded to is giving clients real Peace of Mind.
I mean, seeing the stress leave their body when they're talking to you because they're concerned about do I have to drive to the nearest emergency hospital, which is 3 hours away and it's snowing outside?Or if they live in an island, do I have to now go onto a ferry or buy buy a plane ticket for my animal and then travel over somebody of water to get to the nearest emergency.
They're worried about finance, they're worried about waking up their kids, they're worried about their cat hating the car ride.And when you tell them good news, I don't think it's an emergency, they're like sigh of relief, you know?And so that I think is probably the number one reason why our vets really enjoy this is they give people real Peace of Mind for cases that are not emergency, we can do some things at home to and then give you give them some time to see a vet in person.
So I think that's probably the number one most rewarding thing.I will flip it a little bit.Let's say you have a a hemo abdomen or a GDV at what you suspect anyways, a GDV or a hemo abdomen at home.And that same scenario, it's a plane ride, it's a ferry, it's a 3 hour drive in the snow.
Basically emergency is not an option.What can we do for that animal at home?And we have scary scenarios like that where even though it's stressful to our veterinarians because nobody's advocating that GDV stay home, but that client has no option.There's no option.
And so they collaborate and even giving that client just education on what to expect, what to do at home, knowing that it's severe.But we're trying to do the best we can with with what we have.It gives our vets enjoyment because that person with that GDV, had we not existed, would have to watch their dog die a painful death without any knowledge of what's going on with their animal.
At least with us, we can help educate them and maybe even keep that animal alive until they can see a veterinarian.So it's a daunting task, but our veterinarians, I think, take pride and joy it that they can help give that person some perspective.
Very cool insight.Is there anything that I'm missing from that perspective or do you think we've covered it pretty?Well, I think folks should know that this is not the end of it.It's gonna continue to evolve the world of Tele robotics, Tele diagnostics, Tele mentorship, Tele monitoring.These are all things that are already in the works in real life or are pending.
But there are some cool things coming down the pipe.And then when you look at augmented reality, virtual reality, and how they can play a role with virtual care, there's gonna be some cool stuff coming the next 5 to 10 years in this space.So I would say this is just the beginning of it.There is a ton of stuff happening.
And because we're at the forefront of this, I hear about this stuff and I get to talk to cool companies and cool people about what they're doing and it's very exciting.So I would say that one thing to add to this conversation is look forward to the future because this is just the beginning of it for anybody who who doubts whether or not telehealth is a viable field.
We are past that.We're going on to another realm with this stuff.And this is just the basics.So do you have time to dig into the perspective of a business owner saying, do I incorporate this either through outsourcing IT or through incorporating new things in in the way that I practice?
I'd love to talk about that.Let's jump into the stuff you just mentioned, the future out of the things you briefly listed, a few words in that immunity I went what?What's that?What's the coolest thing that's coming or is here and but not commonly known yet in telehealth That excites, I think.
Telediagnostics is probably the one my answer for that one.Telediagnostics I would define as the ability to monitor certain parameters objectively of a pet and have it be shared instantaneously with a veterinary professional.So a good example of that that we've been performing is that device for diabetic.
Continuous glucose monitors, so there's a few brands and a freestyle.Libra, that's a, that's a, that's a very easy, understandable, relatable telediagnostic tool.We, we've all been using it for some time now.Very powerful.And that enhances pet care.It enhances veterinary monitoring.It's awesome right there.
There are now diagnostics that you can implement in your hospital that will monitor certain parameters of a hospitalized patient without any wires, without any suction cups.And you can monitor things like temperature, heart rate, whatever for that pet without touching them.
And the device is is doing this all hotel diagnostics, and it'll monitor multiple pets at one time.And that information is automatically uploaded to the cloud for veterinary observation.Also, those tools can have alarms to them so they'll alert you when something seems off.
Those types of Tel diagnostics are now in the hospital setting and my prediction is it's going to enter the pet owners life where they can set up something in their house that monitors certain vitals.Or let's say you have a dog that's prone to seizures and you want to know if your dog had a seizure while you were at work.
Diagnostics to be able to show that whether it be based on erratic movement or spikes in temperature or heart rate or blood pressure, whatever it is, but being able to give the pet owner the ability to monitor their own animal with objective data so they can contact a virtual platform and discuss whether or not that spike in something is of concern or not.
So so Tel diagnostics, we're in the infancy of it, but it's going to be I think huge not just from the veterinary clinical aspect where you can monitor pets more reliably and not rely on technicians and stuff as much, but also home care as a preventive measure to monitor animals.
Say, if you can tell that your dog all of a sudden has a increased body temperature, is this the beginning of something or is it stress or what is it?And you can catch diseases earlier that way.And that's of course better for everybody preventative care, right?So that's, that's an example of where where this is going to go with.
And I have ideas that I can't disclose, but we have things we're going to implement here hope the next two to three years with that triage and how it ties into telediagnostics.So that's going to be a cool and up and coming field in the space.That is very cool.Are they devices out there now that you've come across that work that people are using?
So one company that's at the forefront of this is Zometica, I think they're based in the US, and they have a device called Vet Guardian, and it's like the size of an iPad, basically.And it monitors these parameters using thermal imagery, so thermography.And it allows the clinician to upload this information to the cloud and they can monitor the patient continuously.
You just attach it, you attach it to an IV pole and have a point at the animal.And there you have it.No wires, no Holter monitor.Oh really?So there's nothing attached to the collision at all?What can it check that sounds like so?Body temperature, pulse rate or heart rate movement of the patient because not only does it have thermal imagery, it actually has a real video camera attached to it too.
So the patient is moving.You can tell that as well.I had to look at the other other parameters but those those are the ones that I off off top my head that I know of.How does it do hard?It's it's all thermography.They have clinical trials on this and basically this is of course me trying to answer your question of being based on the thermal pattern of the patient.
It you use an algorithm, calculates and figures out the parameters.That's really good.I'm glad you told me that because if I saw that online I would be like bullshit.Units are like $5000 apiece.I mean, you have to be able to use it and break even on it, right?
So you need a facility that warrants this type of thing.Where I work now out seizure monitoring tool is a color with bell zone that we can hear them seizure.This is this sounds better, it sounds.Great old school measures work too, you know.Hey, nothing wrong with it.
Nothing wrong.Pivoting to the standard, your sort of stuff till the trio having some sort of a service where you can communicate with clients, not in person as in not physically in in in person.Lessons learned for you guys are they stand out things, maybe things that you thought were going to be challenges that were easier than you thought, but you went, oh, this works much better or vice versa.
Stuff that blindsided you a bit I did not expect.That long list.So initially I thought the biggest challenge was going to be to hire veterinarians.I thought veterinarians are not going to want to do this.They want to be in the hospital using their hands, using diagnostics.And I was wrong.
I'm always sitting on 150 plus applicants ready for work.I've had no problem.It's crazy, Hugh, it's crazy.I've never advertised for vets except when we launched our equine platform.I had to advertise for equine doctors in in in less than a month.
I was able to staff our platform 24/7 with equine veterinarians less than a month.It takes hospitals years to find one.It's crazy.If I wanted to create a platform that was all nurses, I could.
I could fill it in a month because I get applicants.Now I'm not even asking for nurses, and I get applicants from nursing.Hey, when you're ready to hire a nurse, let me know.I'm interested.It's out of control.So the application part of it was a surprise to me.I actually thought the veterinary field would hold on to this right away, but the culture has been the opposite.
Trying to convince veterinarians that telehealth is a viable means of practicing veterinary medicine has been the hardest part of all of this because veterinarians, as you know, we're hard.We're difficult to change.We don't like change.We're always skeptical of things.
You know, we're always worried about bad ethics.We're worried about bad medicine, and we're worried about money being taken out of our pockets, right?And so I didn't realize, maybe foolishly so, that the veterinary culture would be hard to to steer into that direction where they view telehealth as a really powerful method of taking care of animals.
So that was a surprise to me as well.So those are just two surprises that I learned over time from doing this.Is that changing?Are you finding a more of an acceptance as it's becoming We've had some time to get comfort.On the non equine, absolutely any practice that doesn't practice on large animals, production animals, they are much more likely to adapt this technology.
Large animal is a different story.They are much more difficult to convince.Equine vets especially have been used to being on call 24/7 with the clients having their cell phone forever.And we launched the equine platform two years ago and it's still very slow to ramp up because they're so scared of clients being upset that they can't just phone you right away anytime, day or night and to hand over their clients to us so we can manage their after hours on call so they have more work life balance.
That has been a huge struggle.That's that's so weird, I would have thought of the exact opposite.That'd be so so sick about.I mean that's a large reason why I never wanted to do large Is is the constant on court.I reckon they've got Stockholm syndrome.The equine vets they so used to being hostage to their clients.
And and we still we are getting more and more equine partnerships over time.So it's it's moving in the right direction, but still compared to non equine, very slow.You would think that after they've tried all the other things to manage their quality of life and all those other things have failed, they'd be willing to try something new.
And they're very, very slow to adopt.So we're going to keep trying.We're fighting.We're fighting the good fight because we know it's the it's an answer to their problem.We're using them to be able to let go of the reins, no pun intended, and let us control their after hours on call.Good plan.
I'm going to circle back to, to your massive list of, of people who want to work in it.I think that that's worth pointing out, worth underlining for practice owners, brick and mortar practice owners to say that if you, you know, we're trying to create workplaces that people want to work in.
It's the whole stuff finding and stuff retention thing.And it, there's clearly there's a desire for this sort of thing.So maybe setting up something as part of your your business model where your staff have the opportunity to do some of this might be very attractive, might might actually be a recruitment tool.Yes, so I, I love that you said that we've had plenty of hospitals that use us for their after hours on call who are trying to hire new vets, especially new grads and the new graduates don't want to be on call and in order to entice them to join that practice, they'll say, look, you're going to be on call.
There's no way around it would live in a remote area.However, vet triage has decreased our calls by 8090%.We almost never get called in.And when we do, it's really an emergency.So you're not getting bullshit.You're it's an authentic real case that a veterinarian has seen and triaged and deemed an emergency.
So they've used that.They've actually asked our permission.Can we use the fact that we're partnered with you to get this doctor to come join our practice?And we're like, absolutely go for it.That's the point of work life balance.That's the whole goal here is to help veterinary clinics with, with balance.So yes, it helps with recruitment, it helps with turnover.
If you're an emergency hospital and you know that your staff is sick of seeing the ear infection and the limping puppy, things that are not an emergency and that's creating stress.Well, if you can partner with vet triage and send us those cases so we can triage them away.You can focus on the pioneer, the GDV, the seizure in case, and we'll handle the allergic reaction, the ear infection, the whatever.
And then you keep your staff because now they're not stressed out and annoyed all the time, right?How many times in your ER hospital, Hugh, did you hear of a technic or an assistant or a doctor say why is this case here?Why are they here?Right.It's always and, and I don't blame them.They've got a septic abdomen and a post op splenectomy.
They have big cases to deal with.They don't want to see this barking loud puppy coming for one bout of diarrhea at 3:00 in the morning.So it helps with turnover and hiring all the way around if you can leverage telehealth.OK, Challenges in that regard, unexpected challenges, the things that you tried or if I'm in mistakes or where people get stuck.
It's the, the medical records.And this is just like brick and mortar, right?Like if you have, if you're in charge of the team, let's say who you, you own your hospital and you're in charge of all these doctors.You know that doctor A writes beautiful records, Doctor D terrible records, right?And you, we need tight medical records.
That's true in brick and mortar.And it's especially true with us because we are limited.We, we have, we don't have the cushion of blood work or urine test or radiographs.So trying to get them to write medical records.I would love if they wrote it the same way, but of course I can't standardize it that way.There's 70 doctors and I don't want them to all be me.
And I'm by no means the perfect solution to this.So I just want thorough medical records and consistency.Everything you told the client that you spoke about, even if you don't think it's important, put it in the record, type it in there, right?What about the technology side of it?
Because you of a you told me you guys built it all out the box your own platform.Why is that?So let's say I'm AGB practice, but I want to start using some sort of telemedicine and I'm looking at I'm not going to build my own platform.Why?Why did you guys choose to make your own?
And if you're in a different scenario, watch should you look out for or be wary of or what are your requirements?That's gonna take the right boxes for you.So for us, we first of all, we did not want to have an app.We wanted to be where the client can go on the website right away, pay and be on with the vet because we're dealing with emergencies.
So for them to have to go to the App Store, download it, then create an account, it's going to create barriers.So we made it where it's web-based on ours and not just web-based, but it's agnostic to any device.The other part of it too is we want also to have a platform that we can evolve.So I'll give you a good example of this.Right now, as it stands, if you are providing telehealth within a brick and mortar, you are required to maintain medical records in compliance with standard brick and mortar medical records.
If, however, you're providing telehealth outside of a brick and mortar, there's no rules for that.And so you can write whatever crappy notes you want if you're not related to a brick and mortar and as that's fine, it's your prerogative.My prediction was we will eventually not only need actual medical records, but we will eventually probably need our own EMR electronic medical record with, with client information, pet information.
So I want a platform that we can also then evolve as the rules evolve.And of course it's things like quality.I want good quality visual, I want good quality audio.I want cybersecurity, so we're HIPAA compliant even though we're not required to be in the veterinary space.I wanted the ability to control the stuff and honestly, just from a standpoint of just being cool.
If I had to use Zoom or Skype to do this, Are you a real company?Like you're, you're bleaching off some other platform?I want to own the damn thing and, and be a big boy in the field.And so we wanted to be put in the money and the time to build something that's truly unique.And then lastly, I'm a veterinarian.
I want the platform to appease me as a doctor.If I hate my platform, how can I expect another doctor to like it?OK.But it's a very different vision for somebody else who wants to say add some element of telemedicine to this, to my brick and mortar business.
So if I was a clinic owner and I want to start doing Tele consults, I'd immediately gravitate just to what say, as you say, Zoom or WhatsApp calls or something like that with my clients.Any reason why that wouldn't?No, you can provide this medium using any video device you want as long as you you believe it's secure, meaning no leaked data or whatever else, right?
Even though again, confidentiality is not a big a big deal in the veterinary space like it is in the human space.As long as secure platform, then sure, you can use whatever you want.If you can leverage telehealth in your brick and mortar, you don't want to necessarily invest a lot of money into it, but you want to make it useful.
The only thing though, Hugh, is that it didn't seem to really catch on.Once we started that triage.There was, there were other companies that came out afterwards and their business model was leasing out their platform for vet hospitals to use.And, and in the beginning, during COVID, it they, they blew up.
I mean, they were popular.Everybody thought they'd be doing.And then you quickly find out that veterinarians don't like to be on video.If they're in a hospital, they want to use their hands and run diagnostics and do stuff.If you're stuck on a video call in a hospital, it's kind of like, what am I doing here?I'm, I could just have them come in and then I'll just palpate the animal, you know, so it, it quickly ran out of steam.
I don't know where the numbers are now, but as far as I can tell.They're not even on the radar anymore.So there's a message that's clear where veterinary hospitals, although they could leverage telehealth, make their lives more efficient, it doesn't seem to appeal to them as much.
Yeah.Because they're based on conversations I've had on here, the idea of saying, OK, I have a brick and mortar practice, but perhaps it makes sense in terms of productivity and also balance for the staff to say, well, Doctor X, she's going to work from home on Thursdays and she's going to see all of our rejects via video call, you know, follow up with all these clients or talk to the diabetic patients, have a Tele consult, which makes sense.
But it is interesting that it's not actually taking off.But for that you could just sit.You can have your perms open at home and you can have Zoom on your other screen or what's up, whatever, any, any of the many ones.And I literally quadrupled your appointments if most of them are are virtual, right, People can work from home.
If you have a veterinarian who's pregnant and you know, she can still work, but she can't be there.Yeah.And so I agree, I think it's a cultural problem #1 veterans still don't see if you're an employer, you may not see it worth paying a vet 6 figures to be at home.
And then the other thing is technology, I will tell you, we have a whole customer service and a development team.It is a pain in the ass because most people have bad Internet, bad devices.They're they're, they're older, you know, they don't know how to use technology.Their Internet drops, their cell phone dies.
And so I think that trying to set up a zoom call with a client who is not very tech savvy is a pain in the ass.So I I wonder if those two reasons are are why?So to clarify, it's a pattern As for you guys as well.Is that one of your operational?Problems.It's just, I would say it's a challenge, but we have teams that take care of it.
I have a dev team, I have customer support, they handle it and it's knock on wood, it's worked very, very well.But we also do this full time and even though it's a challenge, we've mastered it because we do this 24/7 for over 5 years now.I think I'm done with my questions.
Is there anything we haven't discussed that people need to keep in mind?Or any piling messages or anything that have missed?Oh.Man, I think that's great.Your questions are always intriguing and I welcome any other discussion in the future with you.It's always fun.Cool.Where can people find you if they listen to this and says, well, I think I need to outsource my after hours from, as we said anywhere in the world.
Where do we?Where do we do?That triage.com, it's VETTRIA ge.com.There's a, a contact form in there you can fill out and then it'll, it'll, I'll get the e-mail directly or our business partner will and you can inquire.But also we have lots of social media.
There's my name, Doctor Shadia Rafich in Instagram.I have a YouTube channel, We have a vet triage Instagram.And so you can message us, DM us, whatever through any of those platforms.Cool, I will put links in the show notes as well or in the show description when you're listening to this shady.Thank you so much for your time.
It's really interesting topic and I think it's it's one of the episodes that I think are going to get more listened because as you say, as the culture shifts, people want to think about this more and more and more.So thanks for doing it and and doing all the hard work for us to get it done running.Thank you very much for that, for your time.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 pills.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 my 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 Shadi Ireifej