June 3, 2025

#143: How to Talk Money Without the Cringe: The Mindset Shift Every Vet Needs. With Dr Bing Zhu

#143: How to Talk Money Without the Cringe: The Mindset Shift Every Vet Needs. With Dr Bing Zhu

We get into one of the most emotionally charged aspects of veterinary work—talking to clients about money. Dr. Bing Zhu, a specialist in small animal internal medicine at SASH, brings a refreshing, deeply empathetic, and logical perspective to the table. With extensive experience navigating complex cases and large treatment estimates, Bing offers a framework for communicating cost transparently and ethically, without carrying the emotional burden.
Dr. Zhu discusses her evolution from guilt-laden money conversations to clarity and detachment, crediting a pivotal mindset shift taught by a mentor: "It’s not you ordering the tests—it’s the patient who needs them." The episode explores how this reframe can reduce emotional stress, improve client trust, and lead to better outcomes. She also offers insight into setting expectations, handling ambiguity, discussing diagnostics versus empirical treatments, and setting professional boundaries to maintain mental health.
This conversation isn’t just about estimates—it’s a roadmap for aligning clinical responsibility, client communication, and personal wellbeing in veterinary medicine.

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Season 1

 

What’s your least favourite part of being a vet?

Is it talking about money?

 

In this episode, we take on one of the most emotionally charged parts of veterinary life: discussing high-cost treatments with clients .

Our guest is Dr. Bing Zhu , a Small Animal Medicine Specialist from SASH, who’s had these conversations more times than she can count, and she shares her hard-earned wisdom on how to approach these conversations with empathy, clarity, and confidence.

Here’s what we unpack:

  • The emotional and ethical weight vets carry when finances and medicine collide
  • Dr. Zhu’s step-by-step approach to setting expectations and guiding tough decisions
  • Why separating your ego from the medical outcome can save your sanity
  • The cultural mindset shift the profession needs around money conversations
  • How to anchor your boundaries in your core values

 

Dr. Zhu shares transformative personal stories, communication strategies, and mindset shifts that will help you communicate more clearly, protect your mental health, and better serve your clients and their pets.

Whether you’re still at uni, starting out, or have been in practice for decades, this episode will change the way you handle financial conversations—forever.

Ready to rethink “the money talk”? Hit play now.

 

Upcoming conferences that I’m excited to attend:

  • Vets On Tour snow conferences in Wānaka, NZ (August ’250), and Nozawa Onsen, Japan (Feb ’26)
  • ANZCVS Science Week, 24-25 July 2025
  • IVECCS 2025 , San Diego, September 4-8

 

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Episode Topics and Timestamps

01:45 Presenting the Large Estimate: How Does it Make You Feel?

06:04 The Turning Point: It's Not Your Fault

10:46 Practical Advice For Handling High Cost Estimates

31:04 Stop Avoiding Referral Because You Think You're Saving Your Client Money

36:25 Why Competence Makes Talking Money Easier

38:16 The Cultural Shift Vets Should Make

44:55 Setting Boundaries and Work-Life Balance

55:39 Dr Bing's Podcast Recommendations

56:19 The Pass Along Question

 

How to Talk to Clients About High-Cost Treatments Without Guilt

When discussing high-cost treatments with clients, it is common for veterinary professionals to experience feelings of guilt, nervousness, and a sense of emotional responsibility for the cost and outcome. This can stem from a desire to be liked by clients or a worry that clients might perceive the vet as trying to "sell" unnecessary services. However, Dr. Bing Zhu, a specialist in small animal internal medicine, offers a transformative approach to navigating these challenging conversations, focusing on clarity, empathy, and detaching personal ego from medical decisions.
Here's how to approach discussing high-cost treatments without guilt, drawing on the provided sources:
Shift Your Mindset and Detach Your Ego
    • Recognise that the pet needs the tests or treatments, not you. As Dr. Zhu's mentor advised, you are merely the messenger. This shift can significantly reduce feelings of guilt and responsibility for the cost or the fact that the dog even needs tests.
    • Reframe your language from "I want to do this to their dog" to "Georgie (the pet) is telling you he needs this" or "Fluffy says he needs this right now". This subtle change in wording helps externalise the decision-making process, making it about the patient's needs rather than your recommendation.
    • Understand that it's not your job to judge how owners spend their money or how much they are willing to spend. Some owners might pull money from shares or sell cars for their pet's healthcare, while others with expensive cars might not do an ultrasound. Your role is to facilitate the owner's decision based on the pet's needs.
Communicate Clearly and Proactively
    • Start with the "endpoint" in mind and work backwards. Explain the potential categories of diseases, their possible outcomes, and why specific tests are necessary to understand the situation.
    • Clearly explain the risks of not doing tests or treatments. For example, if an owner skips an ultrasound, they must accept the risk of an underlying condition like cancer going undiagnosed. If they opt for empirical therapy, explain that it might lead to more frustration, potentially higher costs in the long run, or even worsen the patient's condition. But do this without judgement or creating guilt - it's about pursuing the best outcome for your patient in a framework that is practical for your client.
    • Frame choices as a consequential, rather than arbitrary options. This empowers owners to make an informed choice while understanding the potential consequences.
    • Have frank, upfront conversations about potential costs and outcomes before embarking on a journey. For high-cost procedures, openly discuss survival rates and long-term prognosis. This initial in-depth conversation sets realistic expectations and allows owners to decide if they want to take on the potential down sides.
    • Do not present equal options if they are not truly equal medically. This can make the process seem arbitrary to clients, like "picking things at a shop". Instead, explain the rationale behind your recommended diagnostic pathway and then the potential repercussions of alternative routes.
Enhance Your Competence and Value Your Time
    • Confidence comes with competence. When you are clear and confident about what a patient needs, clients are more likely to trust your recommendations. This confidence is built by continuous learning and preparing for consultations.
    • Consider early referral if a case is beyond your knowledge, equipment, or time capacity. While some vets may delay referral due to ego or a desire to save clients money, this can ironically lead to more money being spent on inappropriate or ineffective treatments. Specialists can often better direct owner finances by providing a logical pathway.
    • Value your time and charge for it. Vets often spend significant unpaid time thinking, researching, and communicating with owners about results, unlike human doctors who bill for follow-up appointments. Charging for this intellectual work, perhaps through longer, dedicated consults, helps acknowledge the value of your expertise.
    • Recognise that your value lies in your thinking and service, not just products or procedures. Your ability to perform a complex procedure quickly is a result of years of training and experience, which clients are paying for.
Understand the Broader Context
    • In countries like Australia, where there isn't a Medicare system for pets or widespread pet insurance like in the US or UK, the cost of veterinary care can be a significant shock to owners. Acknowledge this reality by saying, "I know it's really sad that we don't have Medicare for pets".
    • Be aware that complaints often arise from unexpected additional costs or from having spent a lot of money without resolving the initial issue, underscoring the importance of transparent and comprehensive initial discussions.
By adopting these principles, veterinary professionals can navigate high-cost conversations with greater ease, fostering trust with clients and ensuring the best possible care for their patients, without the burden of guilt.

 

 

The Case for Earlier Referrals: Saving Clients Money and Stress

The case for earlier referrals in veterinary medicine can significantly benefit clients by saving them money and reducing stress, primarily by ensuring that financial resources are directed towards effective and appropriate diagnostic and treatment pathways from the outset.
Here's how earlier referrals achieve this:
  • Preventing Wasted Expenditure on Ineffective Treatments:
    • Veterinarians frequently observe situations where clients have spent significant money on repeated, inappropriate, or ineffective treatments at a local primary care level before being referred.
    • Dr. Zhu notes that when owners eventually come to her with very limited finances, it is often because their money has already been spent on "the wrong thing".
  • Directing Finances Logically and Efficiently:
    • Specialists can often better direct an owner's finances by providing a logical and structured diagnostic and treatment plan.
    • Instead of performing tests that may not lead to an actionable outcome (e.g., an ultrasound for kidney disease if the owner cannot afford subsequent surgical interventions), a specialist can guide owners to invest their finances in treating the treatable diseases. This upfront, often hour-long conversation, allows owners to make informed decisions about where to best allocate their resources.
    • In the US, the culture of early referral means that primary care practitioners might refer a pet with newly diagnosed diabetes or kidney value elevations to a specialist to develop a plan, which helps optimise the owner's financial outlay.
  • Reducing Client Stress and Frustration from Unresolved Issues:
    • A significant source of client complaints, particularly concerning money, stems from unexpected additional costs or having spent substantial amounts without resolving the original issue.
    • Early, comprehensive discussions—which can sometimes take 40 minutes or even an hour—about potential costs, risks, and prognosis are crucial. This allows owners to make a decision upfront about whether they want to take the "gamble" on a high-cost treatment pathway. These kind of lengthy discussions are often not an option in non-specialist clinics due to time constraints.
  • Overcoming Barriers to Early Referral:
    • Veterinarians may delay referral due to factors like ego (desire to solve the problem themselves), a misconception of "saving" the client money, or simply not having the time or expertise to manage complex cases effectively.
    • Ironically, this delay often leads to more money being spent on 'fumbling around' without a clear resolution.
    • Dr. Zhu advocates for vets to recognise when a case is "beyond my knowledge or the time that I have available to me" and refer to a specialist who knows what "properly done looks like" and has the capacity to deliver it.
    • To facilitate this, some primary care practices are beginning to book longer, paid consults (e.g., 30-40 minutes) specifically for discussing complex medical plans, or they refer patients to specialists for this initial in-depth discussion. This acknowledges the value of the vet's time and expertise in guiding these difficult decisions.
In essence, by embracing earlier and more transparent referrals, veterinary professionals can navigate high-cost conversations with greater confidence and less guilt, leading to better outcomes for patients and a more financially and emotionally manageable journey for clients.
What's your least favorite part about being a vet?The one thing about our job that you wish that you could just magic away.I'm going to take a guess that it's talking about money, right?If you are like.Most vets and I definitely include myself in that group.
Then you're well familiar with that sinking feeling right before you walk back into a consul room, estimate in your sweaty little hand, trying to muster the courage to tell that lovely family or that sweet old lady in there that their dogs care is going to cost more than you earn in a month.
If that kind of conversation ties your stomach in nuts, you're not alone.And this episode is for you.I am Hubert Emstra, and you're listening to The Vet Vault, where we unpack the suckiest parts of vet life and figure out how to do them better, one conversation at a time.
Our guest is Doctor Bing Zu, a specialist in small animal internal medicine at SASH and somebody who has had more Let's Talk Money conversations than most of us will have in a lifetime.Bing's approach to this has evolved into something.Special.She's cool headed, unflinchingly clear and deeply empathetic, and her take on navigating the emotional minefield of discussing high cost treatment plans with pet owners is equal parts refreshing and hopefully transformative.
In this conversation, she walks us through how she handles those critical money moments.We talk about guilt only expectations, the weight of responsibility that you take upon yourself, and the critical skill of detaching your ego from medical decisions.You'll hear how Bing reframed her approach because of one piece of advice from a mentor that changed everything for her, and how that mindset shift might just make your job.
Feel a little bit less heavy?This one really challenged me and I think it will do the same for you.Let's get into it with Doctor Bing, too.So the topic is talking money with clients and I'm going to start you with a scenario.I'm very curious how how you feel about this.
So we talked last though about kidney failure and about dialysis and all those sort of things which I imagine none of those things.When we talk about a patient going on to dialysis with you guys, I'm guessing it's not a small estimate that we've that you've got to discuss with clients.
Scenario is you have this patient, you have these clients with you and you've done all the work up and you realize, all right, this patient ideally has to go and dialysis.I need to go talk to the clients about it.And I'm curious how you feel before you go back into that room to discuss that estimate.What's going on in being the head, but also physiologically and psychologically when you have to go in there and say hey, and when it's make it really empathetic, you'd identify with them.
You really like them.Maybe they're a bit like you.Maybe they've got kids in the room, all those little things that you want them to really like you.Yeah.What's kept going on in your head?I mean, in my head has nothing anything to do with anything about how much they like me.In my head, going into those conversations, there's two things.
I hope they really, really love this dog.I hope they have a lot of money, but I can completely understand if they don't and if they choose to stop.And then in my head also and throughout the conversation, we're at what I call one of the critical forks in the road, meaning if we go down this pathway, this is not a pathway you go down if you want to, oh, can we skip this test to save some money or skip that test to save some money?
Because if you're investing a huge load of money into a 5050 chance of this dog making it through or cat making it through, you need to make sure you're not making the small errors.You need to not miss the small things.
You don't want to have invested 20, thirty, $40,000 into a patient and then it all falls apart because I don't know, you were a day late changing an IV catheter and got a catheter infection septic and passed away from that when your original disease was improving.
If that makes sense.Honestly, that's all I think about is like, I really hope these owners are in the financial position to afford to do this.And if they're not, I completely get it.I just have an emotional attachment to the dog and or the patient and hoping that we can give them a chance.
That's interesting.I love that you say it has nothing to do with hoping that they like you because I do think this conversation is very relevant and pointed to myself because it.This is definitely the hardest thing for me about vet signs, specifically working in emergency where there's often there's a high pressure situations, large amounts of money and quick decision making without a lot of time to go and sort out your finances or go talk to the family.
I find it that the reason I oppose that question.How do you feel?I find it quite an emotionally loaded situation and I think part of it, I think this is through years and years of self analysis of why do I find this so hard?Is that desire to be liked as well?
Which I think a lot of vets have.We are generally amiable people.We won't be able to like us, right?We do become vets because we want to help.Was that a thing for you or has it never even been an?Issue so the need to feel liked has never been a thing for me.I know that might just be an oddity for me.
I was saying to my husband there are two categories of vets in general and both provide fantastic outcomes for the patient.But some people are really in it for the acknowledgement that like they're the people who they do a surgery or a procedure and they want the owner to know that it's them and their name and thank them and that sort of thing.
And, and they've done a great job.And then there's the other category, people who couldn't care less whether there was a client attached to the patient at all and just want to know, like their job drive comes from knowing they've provided the absolute best or gold standard care within the whatever the owner can afford.
And if the owner doesn't even know my name, don't care.Or even if they accredited, let's say if I did a dialysis patient or scoped out a foreign body, and even if the owner never knew who I was or thought someone else did it couldn't care less.Like I get no job satisfaction from that side of things at all.
What is a very, very real thing is a sense.And this took a very important mentor in my life with which was probably Doctor Ed Feldman, you know, the writer of Feldman and Nelson in the chronology book and Bettinger and Feldman and stuff.
During residency, I was feeling a lot of responsibility for what tests and treatments I was offering the owners, Like I was dictating everything and what the turning point for me was.
He said to me, Bing, you're not the person prescribing or ordering these tests.It's the dog who needs it.It's like you're just the messenger.That was a huge turning point for me.So when I go into all these conversations, it's really purely about the patient for me and saying, look, your dog could have this, this or this in order to find out these are the tests we need to do.
But I think the part that gets missed, and often it is due to time limitations, especially in emergency, especially in primary care, we've got 15 minute consults.The part that gets missed that leads to all the problems is after saying that it's if it has this problem, it could be this might be the outcome.
If it has this problem, then this would be the treatment or outcome.And having the end point in mind is the key point.I would say if I start with the end point and work backwards, then the owners can understand why we want to do tests because if we don't do them then the owner is taking the risk that this or that bad thing might happen.
Like I think the big shift was I felt guilt and responsibility for the outcome.Guilt and responsibility for the cost of the test or the fact that the dog even needed test.I don't know where this comes from.Like the fact that your dog needs an ultrasound.I felt so sorry or apologetic saying that to an owner once I shifted that mindset like it's not me who needs the ultrasound.
It's it's a dog who needs an ultrasound and it's the owner who needs the ultrasound to find out what to do with the dog that makes sense.Yeah, 100%.I, I get that and I'm listening carefully because I think I feel that too.And it comes maybe and we'll talk about wallet guarding or excessive empathy of me feeling sorry for you because now you're going to have to spend $5000.
And I have an immediate feeling almost of guilt.You're right.Or at least empathy going oh shit.Yeah.This is bad news.It wasn't a way.It's actually really good news because I'm like, well, I, I know what it is and we can't do it.And whether you want to pay for it is up to you.It's not my problem.It's not for me to feel guilty about, but I definitely have that, that, oh, I need to recommend this.
And I worry that they're.Going to to some.Extent I think it is, I worry that people are going to think that I'm just trying to sell them stuff or over servicing them.Is that does that ever come up for you?All the time, yeah.So that's probably the crux of what I used to feel a lot of the time, that I was just trying to sell them stuff that they might not actually need.
I feel like it's an increasing vibe in the public or maybe it's, I feel like it's increasing because it's on social media and I and you see it and you hear people talk about it.So I am more sensitive to going.I just think I want to say we should do, I'm genuinely want to do it.I'm not just trying to upsell you.And you know, it's not the fries with that situation.
So I'm maybe excessively cautious.About it, I also think that Australia is a country where this is more of an issue because in the US where they don't have the, you know, Medicare system paying for the human health bills.
You see your bills or you see how much you put towards health insurance.I was hospitalized for 24 hours in the US during my residency and the total bill for the hospital was $28,000.Now thankfully I had insurance and I only had to cover $1400.00 of that, but I knew that my day costed $28,000.
So when I had clients in the US, the costs were never surprising to them.Similarly in the UKI don't know about the rest of Europe, but in the UK my understanding from colleagues are that even though they do have the NHS, Medicare, covering human side of things, the clients there with pets tend to have insurance for their pets.
So that buffers a lot of the cost and, and the people who can afford pets generally are people who can afford some sort of land or are financially a little bit better off.In Australia we have a lot of land.Anyone can kind of get a PET and not necessarily be financially ready for the medical conditions that come with it.
One situation I frequently get is owners coming to me saying, oh, I can't believe in MRI.Oh thank God I don't do Mris anymore now that we have neurologists, but I can't believe an MRI costs like 2 1/2 thousand or 3000 or something like that.And I used to feel a lot of guilt and stuff like that, even though I know the costs are very just viable.
But now I just say, I know it's really sad that we don't have Medicare for pets.Beyond that mentor saying it to you, 'cause I'm, you know, if it, if it was just up to people telling me wise things, I'd be very wise by now.But how did you move beyond that feeling of guilt and responsibility?I need to do these tests.
That's what it is what it is.Honestly, it was that conversation because I, I was having a really bad day where I had a patient that was in hospital for like 3 weeks and I was really stressing about the finances.The dog wasn't fixed yet.I came in in the morning, examined the dog and it had vomited again or it like went backwards again and the bill was already at like 18,000.
I was walking around incredibly glum, which is not my personality at all.And I remember Doctor Feldman coming up to me and saying what's wrong and I was like, oh, I don't know how I'm going to break this news to these owners that is dog might need a feeding tube.It's gone backwards.I thought it was getting better and I was like, you just tell them, you know, your dog needs this right now.
I think it's a dog called Georgie.It's like, don't say you want to do this to their dog.It's like Georgie is telling you he needs this.Georgie.Like literally reframe every single sentence in my brain to Fluffy says he needs this right now.
Fluffy is throwing us the curveball.Fluffy is like, once I changed my language, I think that was when my mentality started to shift on that side of things.And yeah, that was that was the main thing, because prior to that it was like I was responsible for every time a dog did well or did poorly.
I'm hearing you and I still want to know if this is going to hit home for me because listening to you say that, I realize that is what I do and maybe it's an eager thing, almost like it's an arrogance.Well, I'm deciding and we need to do this.But you're right, that shift of saying.The dog is deciding.The case that the dog, the boy, the nature of the disease, it's not me, it's not my fault.
These are the things.This is why I asked you in my scenario, how you feel about it, because I have, there's two parts to it.I, I rationally, I totally get it.I've run my own business.I understand the finances.I totally value what we do.I can rationally justify everything.
But when it comes to the the talking bit, there's still an emotion attached to it.Yeah, nervousness or a guilt or something like that.Have you moved beyond that?I feel like I've mostly have like there are still some cases where I really feel, you know, right now I've got a case on my hand.The owners have spent $53,000 in two months.
We still don't have a solution for her dog.Thankfully, we've ruled out really horrible diseases, but I don't know whether this is a fixable condition.And I still need a few more months.I mean, this, these owners are really, really nice.But you know, she was starting to say, look, I don't know if I can afford the the finances I need to make it through the next few months to see whether this is even a fixable condition.
But I would say even though I called the owners, I was emotionally sad for the dog.I no longer have that emotional guilt of it being my fault because first of all, I now have that conversation from the get go.Before we embarked on that journey, when the the very first consult I ever had with this dog, I literally said we could end up spending fifty, $60,000 on this dog and not be no better off than when we started.
Do you really want to take this gamble?And so that decision from the beginning was the owner's choice.And it's not my job to judge how owners spend their money or how much they're willing to spend.I used to be a little bit judgy, but The thing is I have owners who like these owners pull money out of shares, sell cars, dip into their super, pull kids out of private school to pay for their pets health care.
I have other owners drive the most expensive luxury cars and won't do an ultrasound.I think I've gotten past of that nervousness.My only nervousness is like, oh, I really hope I can help this dog, but I'm also I've truly in my mind completely understand it.
If the owners say hey, this is where we need to stop.Which is the next important step because one tends to have an attachment to the outcome that you want.I want to do this because I want to do the surgery, because I want to feel good about my shift and not go home because I had to euthanize a dog that I could fix.
And it sounds like you have changed that mindset to be These are the facts.It's entirely your decision, and the outcome of that effect does not affect my emotion.Correct.And I think the only reason that I can get there is due to the shift in the time investment that I put into that initial conversation.
And I acknowledge that that cannot be done in the emergency setting or in a 15 minute GP consult most of the time.But I'll just provide 2 points of reference.The 1st is that my background is that where I did my residency in the US, you did not have to be referred to come see us as a specialist.
You could call up the reception team at Davis and say my dog has collapsed.And then they would, they can book you straight and, and you say I want to see a specialist.So I thought everything from people who would fly their dogs from New York to California just for their appointment to I've only got $300 today and that's all I can spend for my dog this year.
So I come with that backing.And then the other side of things is speaking to our relationship management team at SASH, the complaints from client especially associated with money is because either there were additional unexpected costs, either you forgot to put that in your estimate or let's say a little complication arise, then you had to add on more costs because the dog needed it and you didn't have time to call the owner.
Or the the second reason for the complaints is they've spent 10, twenty, $30,000 but the dog has an unresolved issue and that was not discussed at the beginning.An unreal, unrelated unresolved issue?Or the thing the work, the original thing working up.
The thing that you've been, yeah, correct.So I'll give you an example.Our dialysis cases, the statistical chance of them making it through is 5050.The chance of you, like the dog surviving is 5050.Now of those who survive, on average they'll live about three years beyond that when I launch into that initial conversation.
And sometimes that's a 40 minute conversation about all the risks and things like that.But part of that discussion is we're moving into an area where you could spend this much money and there's a 50% chance that your dog might not make it or we have to pull the plug.
You need to have that discussion with your family and think yourself, is this a risk and gamble that you want to take?That's the mindset shift where I am the one facilitating what the owner wants to do and what the pet needs.I'm not the one responsible for making the call at the end of the day.
Yeah, Before I move on, I did want to ask you that, that patient that you're struggling with at the moment, have you tried Preds?No, but that's on the card.Yeah, I just can't.I can't because there are.Infectious organisms right now, but yes, we there is a, there is a piece of paper in the medicine treatment room at such and it's a patient.
It's a patient on the left side.There's a convoluted squiggly line in the middle and then on the right side it says Preds.The other thing is that I probably do nothing a lot more than GPS do.That's probably a big difference, but I spend an hour thinking about all the options before deciding none of them are better than doing absolutely nothing for the patient right now.
Oh, I love that.We could talk for ages about that.The older I get, the more I do that.Anyway, that's going to sidetrack us.I'm curious because when you, you talk about the dialysis as the, that's an extreme case scenario in my world working in ECC on the East Coast of Australia, we get the tick paralysis patients.
And for us our biggest bills in the hospital will be the ventilator cases.I'm sure you guys get that too.And that conversation is almost easier for me.Again, we're very clear on that because you have such a clear.Yeah.Yeah, yeah, exactly.And we, and again, I can say with, you know, I know the story and I say to people, this is what's going to happen.
Again, definitely not guaranteed.And you're going to spend a crap load of money.I can't even tell you how much it depends on how it's just how long is a piece of string.We could spend 20 and we could spend 60.You're right in or you're out.And if you're in, be committed.Otherwise, let's not even go down this route.
The ones that often are more complicated are the ones that are not that clear, you know, hit the nail.On the.Head vomiting the vomiting dog work up or it could be I could give you a jab of Serena and you'll be fine tomorrow.Or I can spend 1500 bucks tonight to try and figure out or rule out things and those conversations are almost harder A. 100% but at least 50% of my job as someone supervising residents and interns that I find the part they need the most help with is talking through those conversations with the owners.
We've decided in rounds that this dog needs this, this, this test.How do you convey that to an owner and come up with a plan?So I'll give you some examples that I see very frequently.It would be the proteinuric dog.The refit has discovered proteinuria.
The dog is completely fine.It's come in for a vaccination.The refit has found that the UPC is 9.And that's alarming them and it's alarming me.And in the owner's mind, I've got a completely normal dog.Why should I spend $3000 on the initial work hub?
Why should I spend another $6000 on the renal biopsy?Or the other situation would be a cat who again, has come in quite fine, but on blood work you discover a mild azetemia and find out on ultrasound they've got a blocked kidney and they're trying to decide do we place in a subcutaneous Reed or bypass?
But my cat is doing fine.And so this is where going back to the point I made before, I start with the end point in mind.So let's say, you know, I would start that conversation for proteinuric dogs.I would start with these are the categories of diseases that your dog could have.
It could have an autoimmune condition, it could have a or a condition that we can't do anything about like sclerosis and just needs palliative care and the drugs, you know, come with side effects.It could also be secondary to something else going on in the body like cancer or something like that.
And I would literally in that initial consult run through, if you don't do the screening and I don't say it like this, you know, I'd first tell them what their dog needs.And most of the time if I've talked through the pathophysiology of why I need to do what, most donors will just agree to go ahead.
If they don't then especially if I have financial limited ones, I will say that's fine if we skip the ultrasound and chest X-rays, you have to accept that there could be an underlying cancer somewhere that could deteriorate your patient very quickly.
But we're going to be treating for the easily treatable diseases similarly by biopsy or not biopsy.Some will say, well, why don't we just try the immunosuppressives and then if that doesn't work, we, you know, just try the other drugs.And I said that is fine.However, you then have to accept that once we start down that road, if the drugs don't work, we don't know whether we need more or that it's just not working.
Meaning, do I need to add on another immunosuppressive drug, or is it that the dog never had immunosuppressive disease to begin with?If I add on another one, that comes with a whole slew of side effects.Basically, am I treating the right thing correct with the wrong drug?Correct.And then and then also, you know those then your dog's susceptible to a potential infection that could become a problem.
Now if you're willing to accept that.And we might end up having to spend more by retesting multiple times.That's fine.But you also have to understand that once I start down this pred and immunosuppressive pathway, if I want to then go back and do the test, I'm not able to get as accurate an answer.
And if they choose that path like that discussion is all had first time I meet them, if that makes sense.Yeah.And if you choose that pathway, then you have to accept the risks that come with that pathway.And I'm happy to be there, But I'm just warning you there could be frustration ahead.
And I don't say it in a threatening kind of way because I've had many dogs.As I said, you know, I have many people who have limited finances.But I just very clearly explain this could be the outcome if you choose not to do this or that.
So it's a very clear why this is what you.Yeah, I almost made the mistake.I almost said this is what I'd like to do.No, Yeah.This is what your dog needs.This is what your dog needs.And here is why.And it's not even this is what your dog needs.It's these are the diseases your dog could have.
Literally, I kind of go through the differential list.If it's this, we treat it with this.If it's that, we treat it with that.If it's that, we can't fix it.I'm just giving examples.If it's this, if it's disease A, but we try the drug of disease B, we could make A worse.So I start with the differentials and the outcomes first of empirical therapy.
Then I work backwards and go, if we want to try and figure out what's the correct pathway, these are the tests that we can do.If we then don't have the finances to do the diagnostic pathway, we can go down the empirical route, but you then have to accept these risks that come with it.
I was going to ask but I think you mostly answered it.Do you discuss plan A and Plan B versus?This is what I'd like to do but here's another option.We could do X-rays and scans and stuff, or we could just try No I.Never do that, and that's a lie.
Quick break to tell you what's happening with the Vent vault and then straight back to the conversation.If you listen to any of the last five episodes or so then you would know that we are heading to New Zealand from the 10th to the 15th of August for a combined vid vault and vets onto a conference in the snow.
It is a week of fantastic continuing education with lots of free time for skiing or hiking or fishing or whatever it is that you like to do in one of the world's most spectacular locations.It's definitely not going to be your standard.You sit and listen to people talking for hours and hours on end.
We only have about 10 tickets left so go check it out at Vets on tour.com.Thank you also to our key sponsors Hills and Idecs, but if you have to miss out on New Zealand or you are so excited about Vets on Tour that you just want more, here is a bit of fresh news just for you.
We haven't made this officially public, but we have secured our venue and our speakers for Japan 2026.Put it in your calendars for the 23rd of Feb to the 3rd of March.Nozawa Onsen.Think traditional Japanese mountain village Hot Springs, sake served on a tray of actual snow monkeys in natural hot tubs and that glorious Japanese powder.
If you'd like us to e-mail you when we go live with our presale tickets, shoot me an e-mail at info@thevetvault.com or keep an eye on vets on tour.com.And then one last bit of conference news.I'm going to the Australian New Zealand College of Vet Surgeons Science Week again to catch up with the epic list of speakers.
So if you're looking for maximum CE content from the cutting edge of IT science without the snow, then you should come and join me from the 24th to the 26th of July on the Gold Coast right here in US.Now.Just something I'd like to say about Science Week.There's a common misconception that Science Week is aimed just at specialists or residents and that the talks are all just cutting edge stuff and not that practical for your everyday vet.
Not true.Yes, there are some streams where they're totally nerd out on the newest research and the high level nitty gritty stuff, but the program coordinators specifically aimed to cater for GP vets as well.So you'll definitely leave Science Week with plenty of fresh and highly practical knowledge that you can take back to a team in GP land.
Tickets are on sale at vetscienceweek.com dot AU.Links for all of these are in the show description wherever you're listening to this.OK, back to How to talk money with Doctor Bing Zhu.And that's a lie.When I say could do, there are some circumstances where I genuinely feel like there are two options that are very, very equal.
Very rarely are there options that are very, very equal except maybe an emergency.You probably see that more often because the dog comes in for vomiting and you don't know whether it's got a foreign body or whether it just ate something nasty.And then that literally I put the decision on the owners and I don't say we could do this or we could do that.
My conversation and wording would be your dog could have a foreign body and need to end up in surgery or your dog could have just eaten something.We'll get over this in a few days.So which gamble do you want to take?Do you want us to do the test and try to make sure it doesn't have anything?
Or would you rather take your dog home and watch it?But be on the lookout that you need to bring it back as soon as possible.If there's anything that smells fishy or here are the criteria I give you to bring your dog back that you know if it's not getting better or it shows this sign or that sign.I don't say we could do this or we could do that because then it makes the owner feel like it's arbitrary and it's like they're just picking things at a shop, if that makes sense.
And that's not what we do.I'm trying.To think of my wording and but what you said, they aligns nicely with what I've come to and it doesn't always push them in the direction of diagnostics because I sometimes feel like, well, I should really be convincing more people to do the diagnostics because it's medically the right thing.
I think what you're describing there is the right.I'll say to people, my words are often, especially an emergency.I said it's my job to be paranoid because I'm an emergency vet.So I've got to think worst case scenario and worst case scenario for your patient could be XYZ, that could be a foreign body or as you say pancreatitis or something like that.
So to rule those out or to investigate it, here's what I'd love to do.That's a fair chance also that your dog just ate something, right?And he's going to puke 3 more times and be fine tomorrow and I'll give him a jab of an antimatic and we're just going to be fine.But if I'm wrong, if it's not that and it is as you say it is the foreign body, then this and this and this will happen.
So would you like me to rule out the worst case scenario or would you like to take a slight gamble and exactly as you say, and then be very clear with if you're going to go the other route, these are the exact things that you should look out for.And I want you to be back here at 2:00 in the morning if this of XY and Z happens.
And I think the difference between emergency and your job to some extent is that I think you often deal with those complicated situations.We're starting down one of the routes, just kind of burns the bridges for the other stuff from what you're discussing with autoimmune treatments and that where I'm quite happy to wait and do nothing for 12 hours because I'm not going to make things necessarily worse.
I'm not shutting any doors on myself.Yeah, but I would also say that a lot of my job is trying to talk people out of procedures or reviewing the invoice that emergency did and go why did you do all these tests Like now you've just spent all this money where I would have put it towards this or that.
You know, the biggest times that I have run into financial issues is when money has been spent often at local vests repeatedly.Like I know this one dog that had like it was actually a nurse's pet at the clinic who did blood and went all the way to endoscopy ex lap spent thousands with her employer who was the vet.
And then all I had to do was review the blood work from the first two visits from three months ago.And I would have gone down a completely different pathway.And all I did was I was like, OK, your dog has got bone marrow disease.It's going to have either this or this.Do you want me to do the bone marrow, which we could either find cancer or this or this or do you want to try to treat for the treatable?
And then I just gave the dog drugs.And I just wish that dog was referred 3 months ago without spending that $5000.I would say more more of my time is doing that sort of thing, like working backwards and usually when owners have very limited finance coming to me it's because it's all being spent on the wrong thing.
It's really hard to give advice over the phone.We do a lot advice calls all the time and I'm more than happy to help.But I do find that most of us do a great job for the initial instance.But I feel like if you're getting to the point where you're like, I'm not sure whether I should do this or that, you can call.
And sometimes I am able to give an answer.But what I would say is like most of the time when I've met the pet and met the owner and know what their priorities or financial situation are, or sometimes they even like my medical decisions are based on the fact that, oh, they've got a disabled child at home or their mother's about to have knee surgery.
My medical plan would vastly change.Like my recommendation would vastly change after meeting the dog and meeting the owner.And I can't always provide that advice as a kind of second hand story to a reset.So it's one of those things where, you know, in Australia, I feel like the culture has been general practitioners feel this huge pressure that they need to know and do everything and be able to do everything.
And the only time that they refer are when they don't have the equipment for it.Absolutely.In the US, the culture is very different.So I would say so often we would have like diagnosed diabetes, Cushing's, or like the first time the dog ever has kidney value, elevations on blood work at a vaccine.
The primary care practitioners would say, I can keep on managing this and do the best that I can, or you can have an appointment with a medicine specialist, come up with a plan and then come back to me.And that way we were better able to direct the owner's finances.
And for some people that meant going down the full diagnostic pathway of ultrasounds and things like that.For other people, I again, this is so much of my conversation.You know, I get owners coming to me with kidney valley elevations and especially those who have financial limitations.
I'm like, what am I gonna find on ultrasound that you're gonna be able to affix?Sorry, but I say that in a nice way, but there's nothing I can find on ultrasound that you're like, if you can't afford the ultrasound, you're not going to be able to afford sub surgery, You're not going to be able to afford removing a tumor.So then why do that?
Like would you then like to put your finances into treating the treatable diseases?And that's perfectly appropriate.But that's a one hour conversation with the owner to discuss, you know, where would you like to put those finances?And I don't know that most people in the primary care setting have either the time or the experience to then guide what's going to be the most logical pathway.
It's a very interesting watching my own mindset around that and my growth over the years, specifically since starting to do the clinical podcast.I definitely was guilty of that, of not referring or referring really late.And I think it's a combination of a little bit of ego.
I've got this.I literally, this was never me, but I worked with a guy who I once many moons ago, suggested referring to medicine.And he went, I don't know anything.I don't know which, which is laughable.That's bravado.Good on him.But ego.
And the other thing is you might have sought out the problem like it's, it's kind of fun to be the problem solver.And I think the last thing is ironically, and listening to you, it is completely ironic trying to save the client money.Well, I'm not going to refer you to the the space is where you're going to spend all this money.
And then contradictory to that, I'm spending a crap load of money fumbling around and not actually getting anywhere with your patient.Whereas I should have referred you straight away and got me a good do spend the extra money on a console.And interestingly, since starting to do the clinical podcast where I'm much more informed than I've ever been in my career.
And the more I do the podcast, the faster I refer.Yeah, it's just literally like, I know enough to know that this is beyond me.You should go and chat to a specialist.Exactly as you say, beyond my knowledge or the time that I have available to me.I know what properly done looks like.And I don't have the capacity to do that, but I know who does.
Yeah.And, and the other thing I would say is I have travelled around some vets as well giving talks at lunchtime.And you know, these conversations come up a lot because I might be going there to talk about gut disease or kidney disease or something.And then I explained to them, this is what I would do.
And the, the question that comes back always is how do you get your owners to do that?My owners just don't listen or they don't want to spend the money or they don't want to do this.And I was like, yeah, it's a 40 minute conversation.And I was like, if this is a disease process you have a handle on, your hospital needs to come up with some sort of, I don't know, 30 or 40 minute consult fee where you just book them in to discuss the plan.
And if you don't have the capacity or don't want to do that, that's when you refer them to us.Sometimes even for management of like just educating the owner, like giving the owner a one hour lecture so they would listen to you.I have quite a few local vets where they send them to me for the initial discussion.
I don't do much with them, send them home with a plan and they just e-mail me every couple of months like the refit does with this is what's happening.And once I've met the pet and the owner, I can much better give them advice on, oh, I do this test or I change that drug or, you know, all that kind of stuff.
It's interesting listening to you back to the money conversation, but I'm realizing the money conversation for a specific thing.And I talked there about, for example, the the tick paralysis patient or your dialysis.But when you know your shit on a particular topic or on this case, that conversation gets a lot easier.
You have the confidence and the clients do it because they smell bullshit.They realize when you're fumbling, when you're like, oh, maybe we should do this when you seem unclear.But when you say ABCD, this, this, this and this, they go yes or no simple conversation.So confidence and that confidence comes comes with competence as well, which is upskilling also for our younger listeners, understanding that when you are in year 1, these conversations are going to be harder because you're going to lack that self belief and clarity of going.
I know what I need to do, here's what I need to do.Do you want to pay for it, Yes or no?But, and what I would say is that because I had to go through that as well, right, I didn't get to this point overnight.So what did I do as AGP my first year out?I'd read up on all my consults the next day.
If it was a vomiting dog, literally I would read up Ettinger the night before, might be 10:00 PM at night, and I'd write think out, OK, so how would I present this information to the owner like GI or extra GI, that sort of stuff.I would literally go through the differentials so that when I went into the consult the next day, I already had the differentials like the endpoint in mind.
Like these are the things it could be.You shouldn't be reading about work at 10:00 at night.Well, no, I get why you're saying good, but.It's like either I have the stress during the day of the lack of knowledge, or have to then deal with the owners saying that I'm obviously fumbling and then dealing with trying to convince them to do something.
Or I could invest in my own brain by reading a little bit the night before.Yeah, no, I don't have to.And when we chatted about this beforehand on e-mail, you said on your e-mail, this conversation, it's a huge cultural and mindset shift that the veteran profession has to undergo.
Why is it a shift?What's happening or why do you think that?I think 1 is the that we're just for the money, which we know very well that that's not the case.The other thing I think is valuing your time.Compared to human doctors, we give out so much of our time for free.
This probably is a problem more for medicine than other services per SE, but I'll give you an example.I will do a bunch of tests, right?I'll do a procedure.I'll do an endoscopy.If it was my doctor, they would say book an appointment next week.I'll charge Medicare $60.00 or whatever it is.
The Medicare bill is to chat to you for 15 minutes about the result.But what do we do?Sometimes it's not even that right?We've done that where it's literally oh Yep, it was all normal.Thank you.Yeah, exactly.But but like, but they still bill, you know, Medicare for that.
But what do we do is that we do the blood test, we do the procedure, we get the results back.We then call a specialist, we call the pathologist.We then spend 30 minutes talking to the owner at 7:00 PM at night after our day is done and we don't charge for any of that time.
And I feel like 1 cultural shift that ideally should happen is if you've got a big case.I'm not saying we need to do this because I still do this.I'm constantly reporting that test without charging for it, but trying as much as possible for things where you get a result.I would say the classic would be stones, right?
Like you take out a bladder stone and then I would say book, book the owner in for an appointment, like a 30 minute appointment 4 weeks later after you cut out the stone.When you get the results back, then have a long paid for conversation on how to manage that, how to prevent it down the line.
And if you don't have the knowledge for that, that's when you book in with a specialist to have that discussion.So it's more about charging for our time because I feel like we give out our time a lot without charging for it.And it's apparent in how things are built.I don't know in specialist practice, but I'm always cognizant of the difference between the bill for surgery and medical stuff.
And very often it's fast it people are quite happy to say, yeah, that's going to be a $5000 TPLI surgery.But the really complicated medical case will often come in way, way less.And it is because of all that unaccounted for, because we're very good at saying when I'm in surgery, doing my surgery thing, I'm billing it.
Really decent rates.Yeah, but when I'm sitting at a book reading up about a case so that I can give you good information and then talk to you about it for ages, well, that's for free, apparently.Correct.Yeah, and that's a huge struggle.Even Sash struggles with that.Medicine is probably the department that loses the most funny.
Like half the time people come in for a procedure and other vets have recommended endoscopy and I'm like, yeah, you don't need that.Let me spend 40 minutes trying to talk you out of that because it's not good for the patient.So first of all, working somewhere with a really good culture because I think the other, and this is a much bigger thing, it's in human medicine.
I don't know how we're going to change.This is being production based where you get a percentage of how much you bill out.You're saying that's a good or or a bad thing?You think that's a possible?Solution.No, I'm saying that that's what leads to these inequities.
So I think the one thing I like about working where I work is my paycheck at the end of the day has nothing to do with like however many procedures I've recommended or anything like that.It's going to be the same every single month or every single fortnight and it doesn't matter whether I've done 10 endoscopies or not.
You know, I don't know how they would do that in private practice, but what I would say is a starting point, and I do know certain GP practices I've gone to, they now have GP practices who there are surgery leaning practitioners and medicine leaning practitioners and they work as a team together where the medicine leaning clinicians don't do any surgery anymore.
And this is like just primary care from how everyone's happy.I don't know how they manage their finances, but they're starting to book longer consults to have those discussions, those medicine patients.Is there anything else on this topic, Bing, that I haven't asked you or that you think is important to discuss?I guess the other thing is valuing your time and getting that experience, like the experience does help have those conversations.
And I would also say this, if it's in the world of endoscopy, endoscopy is the classic thing where, you know, it takes me less than 30 seconds to pull out a foreign body, but I charge the same as someone who sits there for two hours.But the amount of hours that it has taken me to get to the point to pull out something in 30 seconds is what they're paying for.
You know, I will be honest with you.That's one thing I haven't gotten over the guilt for.Because he's so quick.Because it's easy for you.Yeah, that's such a big thing.There's lots of those little things that that are.And again, I think we all do it.Things that you see as super simple and straightforward and then feel guilty to charge for.
I'm trying to think of the ECC examples.There's little things like, you know, dog comes in freaking out because there's a bone stuck in his mouth or something.And then it takes me two things on my but problem solving that.But you often want to say that's OK, don't worry about that.But to the client, it was a big deal.
They thought the dog was having a seizure or something and you miraculously fixed it so well.Well, here's the other way to think of it.If you, if that dog had met someone with less experience, they might have needed to sedate or anesthetize it to get that out and not be able to do that and that's worth the dog.
So if we flip that to endoscopy, if you have someone tugging on a foreign body in and out of the esophagus for two hours, anesthetized regurging, getting aspiration pneumonia, that's actually more harm to the dog than a 32nd, you know, endoscopy.
And then I think the other thing to consider this is more a business owner side of thing is like, are you selling a product or are you selling a service in your brain?Are you trying to make your money off of the dog food and the drugs or you trying to make your money off of the thinking part of you know what you can provide And that shift determines your clientele as well.
Because at least for me, I'm like, save your money on the drugs, find the cheapest place you can get them.I don't care.Go to your local vet to run the blood work if it's cheaper than AT SASH.But guess what you I want you to pay me for is the time to think about like what to do next.
So I think that's that's a big thing for people to think about.OK, that's the money conversation done.But there's more I wanted to chat to Bing about because the first time I emailed her to talk about kidney failure after a specialist friend introduced it to me as the person to talk to about Akii was surprised by the e-mail thread that followed.
My first e-mail to her was my standard Hi Bing, great to meet you, etcetera, etcetera.I hear you're amazing.Here's what I want to do.Are you in being said yes?And thank goodness she did, because the kidney episode we did together was epic.And then we try to find a time that worked.For her.
I suggested a few times outside of normal work hours because that's typically when many of my specialist guests will choose to record when they're not running around saving lives.Being replied.Thanks for your e-mail.I'd prefer to just do this during work hours otherwise it eats into my children's time which I can't put a price on.
Do you have strict boundaries like that in your life?I know I don't, so I wanted to know from Bing where does that ability to draw such clear lines in the sand come from?And is it like that with everything she does?But I laughed out loud at your e-mail.
What did you say in your e-mail?Something about like, you seem to set good boundaries for your life.So I think many people would disagree with you.I agree with you.Just so you know.I agree.I think I set very firm boundaries for myself.
I'm very, very happy with my work life balance.I don't think many people can actually say that.And the reason people think I don't set boundaries, just so you know, I'm 24/7 on call.
I tell the nurses 24/7 if it's my patient in hospital, I don't care.If it's two AM, 3:00 AM, whether I'm working, whether I'm on holidays, call me, but don't answer.Make your own decisions.Call someone else.I'll never get you in trouble for it, but I, you know, call me first.What's the harm in trying?
And I think that's a culture that during my residency, we were essentially 24/7 on call.I had one weekend off every six weeks.If a catheter came out at 2:00 AM, we'd get called about it.And if a dog vomited at 3:00 AM, we'd get called about it.The great thing about that is just like the continuity, like the experience you get from that is great.
And similarly, my faculty were on call if I was scoping a dog at 1:00 AM, I knew if I wander down the hallway, one of my faculty was probably still working and be like, I'm struggling with this, can you help me?Or you know, if I had a difficult case, I'd be e-mail them.Someone was sitting in the airport on their holiday, they'd e-mail me straight back.
So there's been no barriers to from my superiors to me.So I have no barriers to anyone at work.But where I draw my boundaries is if I don't answer, I don't stress out about it.Does that make sense?I feel like a lot of the interns and residents, they get stressed when they get a call from work because they get, I've asked them about this, like, why do you get stressed?
And it's because like, what if I don't know the answer?And I would say that's like, I think it comes with becoming comfortable with not knowing stuff and being very comfortable what you with, what you know and what you don't know.How my days work is.I've got a younger child with a disability.
Like we're on the NDIS.It takes about four to five hours a day for me to feed him due to his feeding disability.So I am one of the few people who leave work on time, on time, if not 10 minutes early, because if I don't, he just loses weight like crazy.
So 5:00 PM to 8:00 PM at night is what I call my Like, don't disturb me unless you're going to pay me half $1,000,000.Like I don't care how much money you pay me, but I will.I'm happy to text people during that time.Like if a patient's weight changes or urine changes because you know, I'm feeding with one hand, I can text with the other.
I also check my work emails every single day and I'm not bothered by it.I'd rather not have a big backlog.I work three days a week, but I do work every single day because work doesn't stress me out.I don't feel the need to cut it off completely.
It's very interesting.To take, I'll tell you first of all, why I said in my e-mail, you seem like you have very solid boundaries is when I approached you about doing the Bruno podcast, you were very clear.You were like, love to do it, love talking about this stuff, but categorically not outside of work hours, which is great.
I thought, well, you have torrid lines in the sand to say, yes, this is a yes, this is a definite no.I don't even have to discuss it.So it's OK.And that's unusual and lots of people.You offered to pay me to talk to me outside of my work hours and I said no, I'd rather not have that pay because my priority, like my child's health and well-being, is not worth the money to me.
And so I think people have to think about what their priorities are.Or that new graduate, when I was a new grad, I was like working till 10:11 PM every night because I was reading up on the case of them the next day and guess what?I'm getting paid for it.But to me, that was an investment in my own knowledge for the future.
When I went to the USI was getting paid $28,000 a year.When my colleagues who graduated were in GP were getting paid $70,000 a year, I was getting paid much less.So in my mind, and I was working like 80 hours a week, something ridiculous.And in my mind I was paying to be there, right?
That you know, the difference in salary between my classmate in Australia working a higher paying job in GP versus my residency.That was the amount of money I was paying to gain experience.I'm buying knowledge.Does that make sense?So that's the way I.
Thought about it.Yeah.So maybe the, the answer from what I'm hearing here is balance depends on what you value.Because again, what you describe that, that people can call you at all times.To me that's like, no, that's horrendous.I, I don't want that.I don't want to be a vet when I'm with my kids.
I want to be with my kids that I want to think.About but I don't.I just don't answer.When I'm with my kid.But I would say I know some people you know, some nurses might get yelled at by clinicians for bothering them outside of work.I would never yell at you.I just don't answer.It's interesting.I just realized it because I'm always judging about people like you going, no, that's that's not sustainable.
But now that you say that, if I try to arrange a podcast with you being about the the kidney stuff or something, and you said, oh, let's say, well, this happens all the time.I get guests in the US and the only time that suits them is 6:00 AM or 9:30 PM at night.
I'm like, fuck, yeah, I'm there.Yeah, I've got no problem because that's what I want to do.That's what I value it.That's that's my priority.I want to make good content.Having kids was the best thing for me because like, it just made priorities so much easier.It crystallizes what is important for you.
The ultimate question is what is most important to you in life and understanding that that could shift with time as well.But what is most important to you in life?And are you spending the most hours on what you value the most?Now, if let's say you're a vet, but you actually are a passionate skier or like Motorsports, like semi professional there and you actually value that one more, Why are you working full time in that Shouldn't be saying that, but why are you doing that?
And you know, I have people, people who are working right now, sometimes colleagues who are extremely stressed out by the work situation.Because with internal medicine, if we work a 10 hour day, like when I was working full time, I, I would log my hours for tax purposes and things like that.
I would work an extra 22 hours a week of unpaid hours on top of my 36 this hour work week that was just on average because of all the comms and things like that.And I have colleagues who are very stressed out by that.But then they're equally the colleagues who go on holidays, buy fig scrubs, have the Frank Green water bottles.
And I'm just kind of like, you know, I'm not judging that I'm, I truly am not.Yes, you are.I'm not judging that I'm not.Judging that, but I'm just saying, like, you, you can't have everything.Does that make sense?Yeah.Yeah.A lot of the younger residents and interns coming through do talk a lot about how they're paid unfairly.
Like, oh, my friend from high school who did banking is paid like twice more than I do get paid, paternity, maternity leave, blah, blah, blah, blah.And my answer to that is yes, but you know, they're probably paying a mental health tax.Like you have more job satisfaction and that's what I called your mental health tax.
You know, you choose a lower paying job because that's actually what you want to do.And I would say ultimately our pay is somewhat determined by how much value society as a whole places on what you or what service.
Which can be an indictment on society sometimes, isn't it?But big, Basically, Big says if you're wearing fig scrubs.And if Frank Greenwater bottle did, stop bitching about your savings account doing so.Poor it's not.The fake account because they don't complain about the money because I think we're all in the top 1% of the world.
We're all, you know, not poorly, poorly paid people.But what they complain about is the stress of how much work burden they're under.And my argument would be work less, but like I feel like people don't consider that as an option.You can actually choose to work less hours.
And there are downsides to especially financial downsides to choosing to work less hours.And then you have to decide what's more important to you.Is it the lack of stress or is it the financial loss that comes with working less and then you make that choice?
Yeah, it's, it's funny, I had a great example when I earned my practice in Perth.I had a nurse who worked for me and she was nursing and also studying human nursing and completely on the edge of burnout.She was working so much.
I was.Like why do you work so much?But she had the nicest new car, much nicer than my car, and I was the boss.I was definitely earning much more than her at the time.I was like, why do you have that stupid car?Just tell your car, get a shit box and then drop one of your shift per week so you don't have to service this debt that you have.
She's like, Oh no, I love my car.It makes me very happy.OK, the.Thing, you know, Like, I genuinely certainly don't judge people who have fake scrubs and have their Frank Green water bottles.But I suppose what I judge about is when you're unhappy with your life, whereas I feel like you have more choice and control over your life than you realize.
This is just in general, if that makes sense.I love that.I really love that because of life choices and what I value.We need to wrap up.Can I wrap up with you with with a podcast question and the past along question, right?Are you a podcast listener?
Yes.What do you listen to?I'm currently parenting podcast by psychologists, so like Doctor Justin Coulson's Happy Families and Eliza Presman's Raising Good Humans.Those two podcasts have completely changed the way I talk to clients and it's been the best thing ever.I've had like 0 minimal client complaints ever since.
Because you treat your clients more like you treat a child.Like the the concepts are the same.It's like all feelings are welcome, all behaviours are not.I love it.OK.I'm listening to that on my way to school now.I'm going to focus up.Thank you.Pass along question.So my question from my previous guest for you, and this is something I'm thinking about a lot right now.
How is AI changing things in your everyday veterinary life right now?Where do you see things going?And what do you predict will be the impacts in the future, which could be a podcast by itself, but is it something you think about at all?I haven't.Been thinking about it too much and I haven't personally used it but I do know some people use it to you know when they have really odd cases they'll run the case through AI just to get check the differential list to make sure they haven't missed anything and new thoughts.
I also know some people use it to write like client information, like you translate something medical to Layspeak.I think AI is getting really good at doing that.So save time for people that way.I do wonder about its implications in things like cytology, pathology, radiology.
Like maybe it's gonna be able to do more on that front, you know, with the cell reading machines these days that they have based on AI.So I think that's gonna become a bigger thing.And then I guess what I would secretly use it for, which I haven't done yet cuz I don't know how new is like I type in summarize the current literature around yadda yadda topic, you know, and what's the current research on this and like put it in a summary for me that I would love.
I totally do that.I could show you off air how to do that.Olga listened to my previous episode that just went live.Was me monologuing on how I'm using it.Part of me just worries like what if AI has read it and misinterpreted the results like so.I haven't.Used it used.
It because that level of like I'd rather see the original study.All right, question for my next guest from Bing, not knowing who it is going to be.So this is I guess a bit of a loaded question, but I would say is it what I saw in the US with the veterinary education system versus the Australian universities, including the education system I went through, there was a huge difference.
Not necessarily just the structure and how the education is provided, but also how hard the students are willing to work as well.And my question is, do you think the current university veterinary education system in Australia is providing new grad vets with an adequate skill set and knowledge base to move forward in their careers, whether that's clinical or non clinical?
And what do you think are the strengths and what could be improved?That's a huge question.OK, It's going to have to be this special gift.I pity them.And being last one, the you have a couple of minutes to give one bit of advice to all of the veteran new grads in the world, if you haven't already said it, or underline something if you want to.
I would say live with the end goal in mind, meaning what will you regret or not regret on your deathbed and then put your time towards that.And then don't compare yourself to others, whether that's within or outside the profession.
Every personal career has their own challenges that you might not be aware of.And then the final thing is follow your passion.If your passion pays less than others, think of it as your mental health tax.Mental health tax, I like that.Don't compare yourself to being when it comes to medicine.
You will only make yourself sad because she knows this stuff.I love this conversation.You have lots of insights.I feel like we should do multiple parts.Thank you so so very much for making the time for this.No problem.Thank you very much.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 grant 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 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 Bing Zhu