PetVet October November 2020

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VOL. 3 ED.5 • OCTOBER / NOVEMBER 2020

YOUR CLIENTS MAY

BE COSTING

YOU MONEY

VACCINATION IN THE TIME OF

COVID-19 & BEFORE

THE VETERINARY PARENT’S SURVIVAL

GUIDE TO VIRTUAL

LEARNING

OCTOBER / NOVEMBER 2020

A Practical Guide for Pet Health Professionals

CONTENTS 4

PetVet Advisory Board

5

Veterinarian Life Advice

6

Vaccination in the Time of COVID-19 & Before

14

Dr. Victor Lopez: Perseverance in the Face of Rejection

18

The Veterinary Parent’s Survival Guide to Virtual Learning

10

22

Top 5 Tips to Avoid Employment

Litigation in the Veterinary Practice

26

What is Authentic Leadership?

32 PetVet 10: 10 Things to Do This Month

30

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ADVISORY BOARD

Meet our EDITORIAL ADVISORY BOARD!

PetVet’s advisory board is here to help ensure quality content to motivate & educate Veterinarians and their staff.

Courtney A. Campbell DVM, DACVS-SA

Jenifer Chatfield DVM, Dipl. ACZM, Dipl. ACVPM

“My passions ultimately drove me towards becoming a veterinarian, but when I was growing up I briefly flirted with the idea of becoming a magician. As a veterinarian, the ability to save lives, keep animals healthy, and strengthen the human–animal bond makes me realize there’s nothing more magical than that.”

Alberto Fernandez DVM, DACVECC "The human race will not be possible without the animal kingdom. It is our duty to take care of those that provide to us and to me it is an honor to do so."

Lisa Powell DVM, DACVECC

“People should be so lucky as to get to be a veterinarian. The broad-based education empowers us to be successful in multiple fields and affords us the opportunity to choose how we spend our professional time.”

Julie Legred CVT “I have had the privilege of working with a variety of animals in my career and my passion has allowed me to be involved in teaching veterinary students, interns, residents and other veterinarians. I continue to enjoy going to work every day to help critically ill dogs and cats, and love the client interactions as well. I am proud to be a part of this advisory board to help teach and spread my love for this profession to others in the veterinary community.”

Jill López DVM, MBA “Do something every day to make an animal’s life better.”

“I have worked in many areas of veterinary medicine and veterinary technology over the last thirty five years, and it is amazing how far our profession has grown and paved the way for the betterment of animals' lives and happiness, as well as improving public health issues. It is an honor for me to be a part of this advisory board to offer additional education and opportunities to grow in our profession.”

STAFF Publisher Barkleigh Productions, Inc. President Todd Shelly Vice President Gwen Shelly

4

Chief Operations Officer Adam Lohr

Web Master Luke Dumberth

Marketing Coordinator Alyx Robertson

Executive Editor Rebecca Shipman

Director of Marketing & Client Relations James Severs

Social Media / PR Coordinator Evan Gummo

Art Director Laura Pennington Senior Graphic Designer Jenn Barraclough

Administrative / Marketing Assistant Karin Grottola

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“

VETERINARIAN LIFE ADVICE

your “

& Michelle Evason, BSc, DVM, DACVIM Associate Professor, Department of Companion Animals, Atlantic Veterinary College-UPEI, Charlottetown, Prince Edward Island

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BUSINESS TRENDS

in the Time of COVID-19 And Before

By Jenifer Chatfield, DVM, DACZM, DACVPM

V

accination. The concept itself is a covert fundamental of society and culture today as it allows for significant freedom of movement without fear of multiple fatal diseases. It seems as though vaccine development is moving faster and faster every year—indeed in 2020, vaccine development is approaching warp speed!

But, no matter how quickly developed, no vaccine is effective until administered to the target population. So, how does that even happen when the country’s (and the world’s) population seems to have grown at the same warp speed? Let’s start with a bit of historical perspective.

Vaccination, variolation or immunization are much older practices than one might think. Records indicate that crude efforts towards protection through exposure were used as early as 1000 A.D. in Asia. However, most experts seem to agree that by the mid-1500’s, efforts to inoculate against smallpox infection were wide-spread in China and India. In the late 1600’s, insufflation was 6

the common method of inoculation. Dry scabs might be ground into a powder and then puffed up a child’s nose, or the dry scabs might be soaked in water prior to being placed in the nose. Still, another common method was to take fluid from a pustule, place it on a cotton plug and then put the plug up the nose of the child.

By the 1700’s, trade routes had spread the practice to most of Europe and likely also allowed for the further variations in administration. The Chinese even described a method that amounted to a crude attenuated vaccine by carrying the contents of a pustule (pocky matter) at body temperature for a month, or exposing it to steam and herbs prior to placing on cotton and then into the nose. It’s likely that this handling allowed for inactivation of some viral particles and decreased the overall viral load, resulting in a very crude attempt at a modified-live vaccine.

Fast forward to 2020, and smallpox is no longer the major focus of immunization efforts. Today’s medical sciences use a plethora of different approaches

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Vaccine platforms, current developers for SARS-CoV-2, advantages and disadvantages Vaccine

mRNA

Replicating RNA (replicon)

Examples

Moderna/NIH, BioNTech/Pfizer, CureVac

Arcturus/Duke/NUS, Inovio, AnGes/Osaka Imperial College University, Zydus, London/Morning- Genexine side, UW

Trial phase as of 8/2020

Phase 3

Phase 2

Advantages

Easy to manufacture, does not require infectious virus

Disadvantages Not temperature stable, less immunogenic, more reactogenic

DNA

Viral vectored

Subunit

Nanoparticle

Inactivated

Live attenuated

CanSino, Oxford/ Anhul Zifei LongAstraZeneca, Pfizer/ com, Clover/GSK/ BioN, Johnson&John- Dynavax, UQ/CSL son/Beth Israel

Novavax

Sinovac

Meissa

Phase 2

Approved (limited use) and Phase 3

Phase 2

Phase 1

Phase 3

Preclinical

Easy to manufacture, more immunogenic than mRNA/DNA, longer duration than mRNA, does not require infectious virus

Easy to manufacture, does not require infectious virus, more stable than RNA, temperature stable

Easy to manufacture, more immunogenic, does not require infectious virus, good track record for other emerging viruses

Easy to manufacture, does not require infectious virus, temperature stable

Does not require infectious virus, may be more immunogenic than subunits

Existing manufacturing capacity can be used, inactivation methods well-established, more temperature stable

Existing manufacturing capacity can be used, pre-existing data can be used for deletion, more temperature stable

Not temperature stable, more reactogenic

Difficult to deliver to target cells

May be inhibited Less immunogenic, by pre-existing need to confirm immunity to vector, antigenic fidelity vector may produce unwanted side effects

May be $$, difficult to manufacture at scale, may not be temperature stable

Requires infectious virus, less immunogenic, may not be temperature stable

Requires infectious virus, difficult to clone large coronaviruses, requires attention to sequence to ensure it cannot revert

*Created by and reproduced with permission from A. Rasmussen, PhD, Associate Research Scientist, Center for Infection and Immunity, Columbia University Mailman School of Public Health

to safely stimulate immunity against a number of potentially life-threatening pathogens. Each vaccine type may use a novel platform or delivery system, target a different component of the viral molecule or seek to stimulate a specific portion of the host immune system. While each of these approaches has a unique set of advantages and disadvantages (see above table), all share a common potential point of failure. To be effective, vaccines must be administered on an individual level—no vaccine is effective if it remains in the vial!

The portion of the population that must be immune to confer “herd” immunity varies from disease to disease and is related to how contagious the disease is from person to person. For example, an estimated 94% of the susceptible population must be immune to measles to disrupt transmission. For SARS-CoV-2, current estimates are that 70% of the population must be immune to interrupt transmission. In 2020, the estimated U.S. population is ~330 million. Thus, 231 million (or more)

Americans would need immunity conferred by either natural disease recovery or vaccine to effectively interrupt the transmission of SARS-CoV-2. Current estimates are that ~5 million Americans have tested positive thus far; that’s a very long way from 231 million.

So, how do we administer roughly 200 million vaccinations to individuals all across the country? How long will it take?

Some estimate that natural immunity may only last months rather than years.

So does a vaccination campaign then race against the waning immunity of

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those recovering from natural infection?

Well, we may not know the answer to how long natural immunity lasts, but we do know how to administer mass vaccination campaigns. In fact, much of the infrastructure for such efforts exists in most cities in the U.S. since President Kennedy signed the Vaccination Assistance Act into law in 1962, which provides for the mass vaccination of the population with a focus on pre-schoolaged children. Additionally, the act allowed federal funds to go to state and local authorities to support vaccination of the entire population.

The anthrax attacks of 2001 required life-saving medical counter-measures (MCM) to be distributed and administered to nearly 2,000 people in a very short time period. The survival rate for inhalation of anthrax declines precipitously if MCM are not administered within 48 hours of exposure.

In 2004, the Centers for Disease Control and Prevention (CDC)

established the Cities Readiness Initiative (CRI). The CRI program is a federally-funded program to enhance local preparedness for biological incidents.

The CRI program targets a system of Metropolitan Statistical Areas (MSAs).

Each state has at least one MSA and the total population of all the MSAs together is about 60% of the U.S. population.

The CRI programs are responsible for cultivating relationships with large (and not so large) employers in their local areas. Both government and private employers are eligible to participate in efforts to provide lifesaving MCMs to their employees (and their families) by order that the employer serve as a force multiplier for distribution to meet the CRI target distribution window of 48 hours. Jurisdictions are required to maintain written plans for effective distribution schemes down to the smallest of details. Granular information such as driving routes to likely distribution points in a community is included. CRI

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communities are also required to exercise all components of plans routinely with analysis and corrective actions included in After Action Reports (AAR).

Since the CDC funds CRI preparedness efforts, naturally, the local CRI programs are reviewed by CDC personnel regularly as well.

CRI sounds like a great idea; execution seems assured and wide-spread distribution of MCM appears well in-hand.

But, anthrax-related medications such as ciprofloxacin do not require refrigeration nor injection. So, how does this change things? The good news is that vaccines requiring refrigeration are not a novel invention and such items are distributed nationwide on the daily. Federally funded CRI programs are required to provide logistics for temperature-controlled distribution plans, as well as inert products not requiring climate control.

With climate control and distribution handled, we should turn our focus to administration of a vaccine in such a

circumstance. If the hotly anticipated SARS-CoV-2 vaccine is an oral formulation, then the celebration can begin!

By and large, Americans, and humans in general, are much more likely to accept a medication that is orally administered than one that is injected with that super scary object—a needle! However, it is much more likely that the vaccine will require injection instead of a simple gulp.

Many healthcare professionals are discussing vaccines and vaccine development on webinars these days, and when the nearly inevitable question arises of who will administer all these vaccinations, given the current burden on the healthcare system, these otherwise well-informed professionals are at a loss. Many folks are wholly unaware of the legal framework in place in the U.S. for just these events. In fact, the existing framework allows for a broad swath of trained healthcare professionals to join the vaccine administration team, including, but not limited to, pharmacists, nurses, dentists and veterinarians.

Additionally, all of those appropriately

integrated into the public health response and under the direction of the local public health officer are typically immune from liability while conducting approved activities such as vaccine administration pursuant to a blanket prescription order. The only actions not covered by this umbrella of immunity are those committed outside of assigned tasks or those committed with willful misconduct (Federal Public Readiness and Emergency Preparedness Act (PREP Act)).

I strongly recommend that veterinarians join their local Medical Reserve Corps (MRC) and get engaged, if not involved, in local public health efforts, even outside of a pandemic. Surely during a pandemic veterinary professionals and support staff will find the MRC an incredible outlet for community engagement and soul-satisfaction through community volunteerism. The beauty of integration with the MRC is the “cloak” of protection provided by the program’s practice of full coverage for members while actively employed in assigned tasks.

To the larger issue that will no doubt dominate media coverage and supper table discussions alike, I have no solution. That issue is public acceptance and recognition of the newly-minted vaccine as safe, efficacious and necessary. Accurate information is the only antidote to fear, and if the media coverage of this pandemic to date is any indication, accuracy is not likely to be wide-spread. So, the vaccine may sit idly in a refrigerated container at a point-of-dispensing (POD) staffed by veterinarians and medical professionals alike with no one in which to administer the potentially life-saving MCM. What to do to resolve this?

Veterinarians can begin by making herculean efforts to remain abreast of any developments down the path to a safe and efficacious vaccine. We can also share this information with our colleagues, staff members, clients and anyone who is interested. Tell them it could be worse…at least we are not proposing to stuff a pusssoaked cotton ball up their nose and ask them to leave it there for a few days. 

Dr. Chatfield is board-certified in both zoological medicine and preventive medicine. She has been a practice owner, worked in zoos and completed international fieldwork. Dr. Chatfield’s peer-reviewed publications include pharmacokinetics, wild animal behavior, infectious disease, and assisted reproduction in endangered species. Additionally, Dr. Chatfield loves French bulldogs, Himalayan cats, the dirtiest of vodka martinis and basking in the sun on any Caribbean beach.

Resources 1. Boylston A. The origins of inoculation. J R Soc Med. 2012;105(7):309-313. doi:10.1258/ jrsm.2012.12k044 2. https://www.mayoclinic.org/diseasesconditions/coronavirus/in-depth/herdimmunity-and-coronavirus/art-20486808 3. https://www.cdc.gov/coronavirus/2019-ncov/ cases-updates/cases-in-us.html 4. https://www.census.gov/popclock/ 5. https://www.rand.org/content/dam/rand/ pubs/technical_reports/2009/RAND_ TR640.pdf 6. https://www.cdc.gov/cpr/readiness/mcm/ cri.html 7. Centers for Disease Control and Prevention.

Vaccine-Preventable Diseases, Immunizations, and MMWR --- 1961--2011. MMWR 2011;60(Suppl):49-57.

8. https://www.phe.gov/Preparedness/legal/ prepact/Pages/default.aspx PETVET MAGAZINE

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CLIENT SERVICES

Your May Be Costing You

By Louise S. Dunn

M

any of us have seen MasterCard’s TV commercial where various scenarios show a cost—until you get to the emotional heartstring tug that is “priceless.” In the veterinary industry, we like to describe the bond we humans share with pets as “priceless” (and MasterCard must agree with us since they show an elephant and monkey taking care of the zookeeper).

We also know that “priceless” does have a price. A problem arises when we feel that the care we provide pets is priceless, yet we must charge a price for services and pay the price for quality team members. So, how can we get past this conundrum of watching the price rise for something we consider priceless?

Think about your clients. We have all heard how much it costs us to replace a client, but how much does it cost you to keep a client? Are you trying to keep your clients? Are you doing the right things to keep your clients? Are you wasting money on client 10

retention efforts that you don’t need?

We cannot achieve “priceless” without knowing the real cost of our actions, and the only way to know the real cost is to be active participants in the financial management of the veterinary practice.

It is vitally important to include your team in any discussions about client relationships and how “pricey” those relationships can be for a practice.

Attached to every pet is a human; some humans are a pleasure to encounter, while others are, well…a learning experience. Regardless of the human, all pet owners are looking for exceptional service. They want their pet cared for in a professional, timely, cost-effective manner—and we aim to please!

But just how pricey can delivering exceptional client service get? Moreover, at what price point do we reach the nirvana of client satisfaction and compliance?

Watching some key numbers in your practice

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can help your team follow the effects of your delivery of different client services. Friendships may be priceless, but client relationships are not. There is a price for attracting and retaining clients, and a price for losing them.

And then there are those “priceless” clients we would pay to lose.

So, do you know the price you pay for clients in your neighborhood practice?

getting to know your neighborhood As the Muppet song goes: “Who are the people in your neighborhood? The people that you meet each day.”

Do you know the people in your neighborhood practice? Do you really know your clients?

It may surprise you to find out information about your clients. I’m not talking about skeletons in their closet, but rather why they come to your practice, what they need and how they feel when they come to your practice.

The following is a list of ways for you to find out. None of these techniques are covert or invade their privacy, but all are very helpful in telling you about the clients in your neighborhood: • Net Promoter Score • Quick Question • Customer Effort Score • Survey Questions • Client Advisory Board • SWOT (Strengths, Weaknesses, Opportunities and Threats) Analysis Running some of these studies is easy—simply establish your “Neighborhood Watch Team.” Assign a few of your trusted team members to head up this project, budget their time and funds, let them perform their analysis, and report the numbers back to you and the practice team. You may benefit from having a representative from each area of your practice participate (i.e., receptionist, tech, doctor), but certainly designate a

team leader to coordinate any efforts of the Neighborhood Watch Team.

The team must work closely with the owners of the practice in determining the focus of the team’s efforts. For instance, you may be curious to learn just how hard it is to do business with you.

Do you know? Do you care? You should care, because this may be a silent killer of your client base. Let your Neighborhood Watch Team survey your clients about the difficulties they experience and find out your Customer Effort Score.

Your new team may decide to ask a Quick Question at the time of client check-out. Simply put: “How easy was it for you to make your appointment with us today?” The client will have 3-5 choices covering the range from very easy to more difficult than expected.

Your team could run this assessment for one week, tally the results and report to you.

You may discover that bureaucratic creep has infiltrated your standard operating procedures and is killing your client’s ability to make an appointment, get a medication refill or schedule a progress exam. How does the Customer Effort Score affect your practice? Are clients exiting due to difficulties in doing business with you?

It costs five times more to replace these clients who leave your business. It costs even more to overcome any bad word-of-mouth statements about your practice and how hard it is to deal with you. It may be costing you new clients because they are finding they have too many hoops to jump through just to become a client in your neighborhood.

Conducting a SWOT analysis of your customer service is another way to know what is going on in your area and what your clients are experiencing when they have their pets treated by you.

Keeping Up With The Joneses As anyone in town knows, daily life is not just about knowing what is going on in the neighborhood, it is also about 12

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keeping up with the Joneses. The jobs, the cars, the vacations—believe it or not, it is the same in your veterinary practice. Are you keeping up with the Joneses (the competition)?

In addition to performing a SWOT of your client services and knowing what clients want, you need to monitor some Key Practice Indicators (KPIs) and watch if you are making progress, falling behind or getting ahead of the Joneses. KPIs will help you track your progress and measure yourself against other practices of similar stature1.

The following are some KPIs to consider when monitoring your clients and their satisfaction with you: • New Clients (Average is 259 new clients per FTE Veterinarian per year.)

• Client Retention (Strive for 85% unless the business is in a military or college town.)

• Reminder Response (80% and track which way—mail, email, text—gets better results in your neighborhood.)

Based on your SWOT, you may create some new client service metrics to monitor as you work at correcting some weaknesses you discovered during your assessment, such as the Client Effort Score or your Net Promoter Score.

Regardless of which metrics you choose, they should be relevant to your practice and play a part in your strategic plan for improvement which you and your team developed for the future success of the practice.

Meet The Jetsons And what about the future? The Jetsons are your “clients

of the future.” Facebook, Twitter, QR Codes, remote patient monitoring and telehealth…the Jetsons are up and coming! Sometimes your clients know sooner than you do about a food recall or emerging disease problem because of their social media connectivity. Are you able to service this group of clients?

Returning to the SWOT and client responses, get your team together and have a brainstorming session about how your team interacts with local businesses (both personally and as a member of your business), and what your team hears from clients. Are there any pearls of wisdom from these discussions? Any strange ideas? Sometimes the craziest idea or request may take you into a new world of client service and differentiate you from other veterinary practices.

Since animals cannot drive themselves to us, we must continue to keep our fingers on the pulse of our clients—old, new and future. Client relationships may seem “priceless,” but any business knows that if you ignore your client relationships, you will suffer monetary losses, so you do not want to neglect what your clients have to say.

We must do this for the sake of the pets and the priceless bond that ties us all together. Know your costs and returns on investments in marketing, new technology and client experience. Devise a business strategy to examine your client relationships and formulate a game plan for monitoring, evaluating and improving that relationship. 

REFERENCE: 1. AAHA’s 10th Edition Financial and Productivity Pulsepoints Louise Dunn is a renowned award-winning speaker, writer and consultant. She brings over 40 years of in-the-trenches experience and her business education to veterinary management. Louise is founder and CEO of Snowgoose Veterinary Management Consulting. SVMC works with veterinarians who want to develop a strategic plan that consistently produces results. Most recently Louise received many awards including the WVC Educator of the Year numerous times and VetPartner’s The Life Time achievement Award in January 2016.

Besides all aspects of practice management and mentoring, Louise’s passions include her husband, Joel, her English mastiff Therapy dog, Zuri, her little sister, Annabelle, as well as kayaking, opera and New England Patriot’s football.

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PHOTOS BY CHISHOLM TRAIL VETERINARY CLINIC

why it matters

dR. vIC TOR

L OP OPE EZ Perseverance in the Face of Rejection

By Jen Phillips April

On May 1, 2020, Victor Lopez became a Doctor of Veterinary Medicine. Not only is he the first doctor in his 50+ person extended family, he’s also the first to have earned a bachelor’s degree.

WHY it matters

H

is is a story of the American dream achieved.

“My parents came to this country with nothing. It was hard for my parents to understand my educational path. They don’t come from an educational background and only completed elementary school. After each graduation, they’d ask, ‘Are you a doctor yet?’”

He can finally say, “Yes!”

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WHY it works Victor grew up helping his parents on their Luling, Texas ranch, and probably would have continued in that line of work if it weren’t for one particular sick calf he encountered at the age of 10. He accompanied his dad and calf to the vet where he could serve as a translator for his Mexican-born father.

There, the seed for the veterinarian dream was planted. “This is what I want to do,” Lopez said.

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The road to medical school is rarely an easy one, and in Victor Lopez’s case, it came with not one, but three rejections from his first-choice veterinary school.

He says, “It was discouraging to get those rejection letters. As a Texas boy, I wanted to attend Texas A&M’s veterinary school.” But after three rejections, he decided he needed to look further afield.

“I didn’t want to have ‘what if ’ lingering in the back of my head, so I decided I needed to apply elsewhere.” He was then accepted into Tuskegee University College of Veterinary Medicine in Alabama.

Dr. Lopez leaves those who might find themselves in a situation similar to his own with this piece of advice; “Never give up.”

A web writer since 2005, Jen’s written over 1000 articles on pet-related topics. She works with veterinarians and pet professionals around the world to help them attract and retain customers through effective content marketing practices. Passionate about both pets and digital marketing, you can find out more at jenphillipsapril.com. When not working with her fabulous clients, you can find her eating tacos and practicing her Spanish in her adopted home of the Riviera Maya.

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LIFESTYLE

The Veterinary Parent’s

Survival

Guide to virtual learning

By Natalie Marks, DVM, CVJ

A

s a practicing veterinarian putting in at least 30 hours at the hospital (and of course the countless hours put in catching up on emails, labs and patient phone calls, as well as consulting and lecturing) and the mom of three young kids (second-, third- and fifth-grader) who are remote learning this year, I am bracing for the unknown, the uncharted and the unusual days that 2020 still has in store for us.

I know that with anything in life, failing to prepare is preparing to fail—even if it’s for a pandemic that is making us feel as if we live in controlled chaos at all times.

However, as we all do our best, here are my five steps for surviving the school year ahead:

Stay in Front Most moms I know always want to be prepared.

But how do you prepare for something that has upended your life in every possible way? I think by now we’ve all learned to expect the unexpected, so now we need to turn that thinking into a plan of action.

First, let’s set expectations. I cannot expect the 18

same level of ability for remote learning from my second grader as compared to my fifth grader. Not only are they different ages, but my care-free and fearless seven-year-old is really nothing like my serious and sensitive eleven-year-old. But they both need to be able to make it possible for me to help them get through their school days without taking too much away from the rest of the household.

The week before school started (we are all remote learning here in Chicago), we started going over what every day was expected to be like. Not only how they would get on their Zoom calls and handle themselves, but when they would get their work done, how they would keep tabs on everything, and how they would help me take inventory of what they need and what they have accomplished during their day.

We can all look at our current life situation and bemoan all that our kids are losing, including the in-person interaction with their teachers and the social skills they would be developing alongside the other children. Even my friends who have kids learning in-person have said that school is nothing like it was before COVID-19. Social distancing, constant

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ASK

FOR HELP

I’ve made this mistake too many times in life, not realizing that it actually shows strength and bravery asking for help, not weakness or inability to manage.

mask-wearing, no recess or lunchroom, and the lack of athletics and other social clubs has made everything very different from what we were accustomed to in the most recent past. And, is it absolutely ok to be unhappy about all of this. It isn’t fair to our kids; it isn’t fair to us. But all of us in this profession know from our years in practice that life takes unexpected turns.

We’re stuck in this situation now, but there is good that can come from this. Our kids will be raised to be resilient. They are learning to handle adversity in many forms. They are dealing with being scared about the

unknown. These are all building blocks for their life that will make them stronger adults—as long as we are strong for them right now. Life is a challenge we need to meet head-on.

Ask for Help However, meeting life head-on does not mean everything has to be done completely on your own. My husband and I, who both work full-time, know that we have to come together to find the best solutions for our family to keep us all moving forward. Whether with your partner or on your own, figure out who within your family and friends can

be of help. Establish your village!

I find all too often in life we don’t want to ask other people for help, thinking we are just being a burden, when those very same people could probably use our help, too. I’ve made this mistake too many times in life, not realizing that it actually shows strength and bravery asking for help, not weakness or inability to manage.

I have a good friend who watches our school-update Zoom calls for me (while I’m practicing) and takes notes for me so I can be up to speed on what’s going on at school. In turn, when I’m home, I have her daughter over for socially distanced play dates whenever she has anything for work that takes her away from home.

Helping with school work, technology or just letting a friend vent are just some of the ways we can all help each other take some of the stress off of our shoulders.

Take Time for Yourself Speaking of stress…yes, it’s building up. We can all feel it. We are so busy worrying about work, our kids, our parents, and anyone and everyone in our lives who has been affected by this. But, especially in our profession already riddled with compassion fatigue and daily mental health challenges, we need to take care of ourselves.

Don’t Beat Yourself Up Speaking of taking time for ourselves, a huge component of that is forgiving ourselves. I have days where I drink more coffee than I would like (If my Starbucks closes down again, I will quit this pandemic!), eat the chocolate I swore I would forsake or never quite get my workout clothes on. And that’s okay. Not every day is going to work right. Some days are going to be really, really awful.

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Some days we are going to cry. (Okay, many days we might cry!) Accepting that fact will make this a lot easier.

If you do the best you can to incorporate the three points above, then you are providing a loving and smart environment for you and your family, and you are getting through this as best as anyone can. Some days that means everything goes wrong. I can’t tell you how many times I’ve been at practice trying to put out a fire at home via FaceTime in between appointments.

Whether it is setting an exercise routine and sticking to it, finding ways to make sure you can eat healthy, pulling out an adult coloring book or just setting aside some time for yourself every single day to take a relaxing bath, we can’t be good for everyone else if we aren’t being good to ourselves. Yes, a glass of wine is a great way to end the day, don’t get me

wrong, but we need more than that for ourselves. Make time for yourself to rest and recharge and feed your passions.

This Too Shall Pass At the end of the day, we need to remember that these days won’t last forever. Yes, they may last way longer than we first thought, but they will end. We will find a new normal that works, even if we can’t get back to our old normal.

There will be a year soon when your kids are back in school for the whole year. And those kids will be formed by all of the experiences and trials they went through during this time.

At the end of the day (yes, often with a glass of wine), I like to look at my three little ones and capture this moment in time and think about their kids someday.

(Can you imagine the lecture our grandkids will get from our kids when they

complain that they are bored!?) We didn’t choose to have this chapter in our lives, but we can do our best to keep the narrative flowing in a positive direction. Dr. Marks is the previous owner and current medical director of Blum Animal Hospital, an eleven doctor small animal practice in Chicago, IL, just south of Wrigley Field. Dr. Marks is also a national educator on many topics, including canine influenza, leptospirosis, feline medicine and canine allergic disease and is involved in many national media campaigns. In her spare time, Dr. Marks enjoys spending time with her family, especially her 3 fantastic children and furry child Samantha, also cooking, traveling, reading, going to concerts and being anywhere there is a beach!

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BEST PRACTICES

5 tips to avoid

Employment L it i g ation in the Veterinary Practice

By Ashley Halberda, Esq.

T

he health and safety of our animals is at the forefront of any veterinary practice owner’s priorities; however, it is important to remember the employment regulations applicable to your practice while providing this care.

Veterinary practice owners are enduring increased scrutiny over their business operations, and it is imperative that practitioners comply with applicable labor and employment laws to ensure that their practice runs seamlessly and cost-efficiently. Lawsuits can be expensive and distracting for any business owner.

The following shall provide a few tips and tricks for staying out of a legal battle and keeping your practice on track.

1

Implement and Update Written Policies. Anti-harassment and discrimi-

nation policies and other related policies prohibiting inappropriate conduct in the workplace are an absolute necessity for any veterinary practice. These policies should

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be in writing and included in the Employee Handbook (if you do not have one, you should get one) that is distributed to all employees and readily accessible through the practice manager or employee intranet. Any harassment or discrimination policy should describe the type of conduct that is considered inappropriate and set forth examples of improper behavior.

A written anti-harassment and discrimination policy is a practice owner’s key defense to any claim of unlawful conduct against the employer. Written policies also encourage a harassment-free work environment that promotes employee retention and longevity. This is the perfect time to implement and update any written policies so that your practice can begin the new year with a fresh start.

2

Establish Internal Complaint Procedures. The small size of many offices and clinics fosters an intimate environment where employees

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consider themselves to be friends, rather than co-workers. While this generally creates a congenial atmosphere, oftentimes employees can become too comfortable.

A comment about a person’s age, a joking sexual innuendo or an offensive email meme can quickly turn from friendly banter to fodder for a lawsuit.

Federal law forbids employment discrimination against individuals on the basis of age, race, religion, gender, sexual orientation, disability, national origin or citizenship, among other factors. The laws in this area continue to expand to encompass a myriad of scenarios and circumstances common to veterinary practices.

It is important for you to handle allegations consistently, legally and appropriately. Employees should be encouraged to report any instances of harassment or discrimination, including instances that they personally experience and those that they witness.

Whether it be a complaint of alleged harassment by a co-worker or a patient’s owner, having a written, internal grievance procedure in place at the time a complaint arises will help to ensure that you are aware of the complaint at the outset, and that the appropriate steps

are taken to address the complaint.

A thorough investigation must be conducted for every complaint of harassment or discrimination. Failure to perform any investigation, in and of itself, will expose your practice to liability, regardless of the legitimacy of the complaint. Your legal representative and human resources advisors should always be consulted when conducting such investigations. When dealing with a sexual harassment allegation in particular, emotions are high and employees can become "creative" with the version of events they choose to recall, and there is always divergent interpretations of what actually occurred. The personnel conducting the investigation should be empathetic, but otherwise emotionally neutral to the involved parties in order to avoid any accusations of pretext or bias that could provide the basis for a future lawsuit.

It is critical to emphasize the fact that an employee will not be retaliated against for making a complaint of harassment or discrimination. It is common for a supervisor or colleague to treat an employee who has made a complaint differently, especially in a close work environment. Employees may ridicule

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the complaining employee or avoid the complaining employee entirely. This cannot be tolerated, and for this reason, it is imperative that investigations be conducted confidentially.

3

Train Management on Policies. Managers are the

eyes and ears for practice owners. It is critical that managers are trained on how to respond to employee complaints. They should be wellversed in the practice’s internal grievance procedure and policies, and prepared to follow them upon learning of a complaint. Managers should be trained to report complaints, or even anticipated complaints, to upper management immediately. A manager's knowledge of employee complaints—even if not reported to the practice owner—can be imputed to the practice owner. Such knowledge will impose considerable liability upon the practice if the underlying complaints are found to be substantiated.

It is important to remember that harassment and discrimination can be in many forms. This includes not only improper conduct by a supervisor or between co-workers, but also improper conduct by a patient’s owner. Indeed, on many occasions, employees are alone in treatment rooms with only the animal as the witness. Further, employees at boarding facilities may be alone with another co-worker overnight—a scenario enflaming personal relationships or harassment. Recognizing the proclivity of employees to be placed in situations in which improper conduct may occur and establishing policies and procedures to safeguard against such conduct will keep employees safe and happy, and avoid expensive litigation.

4

Ensure Hourly Employees Are Properly Compensated For Their Work. Wage and

hour litigation is becoming increasingly expensive and burdensome for employers. To avoid this litigation, practice owners must keep track of the hours

worked for all hourly employees and properly compensate them for any such hours. This includes overtime (over 40 hours in a week, or certain hours in a day, depending on state) and breaks (where applicable), and ensuring that employees are not performing any work off-the-clock (such as administrative work). This is particularly critical for any hourly employees who are working remotely. It is difficult to monitor the work hours of remote employees when they are not subject to in-person supervision, and especially when employees are not keeping accurate and detailed records of their work hours.

Veterinary practice owners should also pay attention to any applicable reporting time pay requirements for their state.

Many states require employers to compensate an employee for reporting to work even if the employee is sent home due to lack of business needs, sickness, etc.

5

Maintain Accurate Records. Federal law requires

employers to maintain payroll records for at least four years. Personnel files must be maintained for at least three years. Aside from these federally mandated retention periods, it is in your practice’s best interest to keep employment-related documents.

Maintaining employee time records, including any lunch

breaks provided (if required in your state), will provide a defense against any wage and hour claims concocted by former employees that are difficult to rebut. In addition, requiring employees to acknowledge receipt of handbooks and other policies against harassment and discrimination, and keeping these acknowledgments in employee personnel files, will put your practice a step ahead of any claims of discrimination or harassment.

Following these tips will help shelter your veterinary practice from potential lawsuits so that you can focus your efforts on providing the best care to your patients instead of defending against a meritless lawsuit.ďƒŒ Ashley A. Halberda is a Partner in the Orange County office of Carothers DiSante & Freudenberger LLP, a California-based labor and employment defense law firm with offices throughout the state. Ashley has focused her practice on counseling and defending businesses in labor and employment matters for over a decade. She is also a frequent speaker, author and resource to employers with workforces in California on employment-related matters ranging from terminations, sexual harassment, pay practices, and classification of employees. She can be reached via email at ahalberda@cdflaborlaw.com or by phone at (949) 622-1661.

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BEYOND THE STETHOSCOPE

A

By Angela Demaree, DVM, MPH, CHPC

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s we are finding our ways through this pandemic—deciding when and how to allow clients back into exam rooms, when kids will be going back to school and what life will look like in 2021—we are also wondering what changes are permanent.

What in our lives won’t be going back to how it was, and how do we authentically lead through this uncertain time?

As veterinarians, veterinary nurses and members of the team, we are all leaders within our profession. We field questions from the public in line at the grocery store, on vacation and at soccer practice. This need to always be prepared to answer questions can be overwhelming—and now we are called on to lead during a pandemic.

We are leading our teams and families. Whether we have a job title that states we are a leader or not, each and every one of us has some power to have meaningful and positive influence at work and at home.

We get to choose how we show up, what energy we bring to every interaction and conversation throughout the day, and whether we see the glass as half full or half empty.

The most common question I’ve been getting is, “How do I…?”; “How do I lead my team through a pandemic?” or “How do I show my staff that I care but not be a micromanager or cross that professional line?”

Those interactions got me thinking about authentic leadership, and asking, “What is authentic leadership?”

Throughout my career, I’ve had many positive interactions

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with mentors and some interactions where the experts suggested that I contort myself in ways that were both unnatural and unsustainable. And when I looked around, every woman who had successfully climbed the corporate ladder in this particular environment were nearly clones of each other. They all spoke in the same calm and measured way and had the same mannerisms, and it wasn’t authentic.

So, how do we up-level our game when it comes to leadership and, at the same time, stay true to who we are and connected with ourselves, our families, and the world around us to continue to be our unique and awesome selves?

Melinda Gates1 has been one of the most visible women on this topic of authentic leadership. She often shares how she was unhappy at work, trying to fit into a culture where she was the only woman. She shares her struggles along her journey to find her sea legs and understand that it was okay to speak up in meetings with diverse viewpoints. She shares how she learned that it was okay to align with her core values at work rather than bend to societal pressures or corporate expectations.

But how do we implement this in our own lives?

I’ll share a few ways that have worked for me and helped me to be more comfortable living my life rather than by someone else’s expectations for how I should look, speak and act in every situation.

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1) Put a team around you who believes in you.

It’s said that the five people we spend the most time with are our greatest influences. When I stopped listening to the negative statements, the subliminal messages and uncertainty about accomplishing my dreams, it was easier and more joyful to accomplish lofty goals, live into my values and find my authentic voice. I accomplished this by surrounding myself with mentors, coaches, friends and colleagues who truly believed in me and encouraged me to keep moving forward even when times were hard.

Having the courage and the confidence to speak from your heart rather than your head carries your message further. This has been my personal experience. And when I look around at the leaders who are considered great orators and people who’ve accomplished amazing feats, it’s the one consistent trait that I’ve observed.

2) Know your values.

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Knowing your core values can be incredibly helpful with making decisions in the moment and no longer agonizing over them. For example, some of my values are bold leadership and selfless service.

When I’m in a meeting and I don’t hear a critical point discussed or the board room conversation is in exact opposition to what our stated goals are, I speak up. Rather than agonizing over how I’ll be viewed or if I’ll be heard or respected, I do the hard and uncomfortable task of speaking up for myself and others

to impact the situation positively.

When I feel uncertain about what I should do in a situation, I ask, “Is this action aligned with my values?” I immediately feel more calm, centered and confident in my decisions.

3) Know your Boundaries.

Boundaries are another critical piece of this puzzle.

Knowing in advance what you will and won’t be swayed on and where you can compromise is incredibly empowering.

Brenè Brown shares that, when she feels resentful, it’s oftentimes because she didn’t maintain a boundary in her own life. So rather than feel resentful, angry or hurt, if instead, we communicate boundaries clearly and kindly and are consistent with maintaining our boundaries, we might just find our sea legs too. While this can be uncomfortable in the moment, it can be empowering and build confidence to lead authentically.

4) Set an intention in advance.

Take time each morning or the night before, just five or ten minutes, to think through each appointment, each phone call or activity on your calendar, and ask yourself, “How do I want to show up in this situation?”, “How do I want to feel?” and “How do I want to interact with my clients and team today?”

Inevitably, something unscheduled crops up that is not a true emergency, but it’s urgent—at least to someone it is—and it may or may not need to be addressed in that moment. Take time to think through what is needing your attention right now and what can wait. Then ask, “Can we schedule time in 20 minutes, one hour or tomorrow to discuss this so I can give you my full attention?”

5) Figure out who you are and who you want to become.

I recognize that is a huge and lofty statement, and I promise it’s not a flippant one. Visualize who your best and highest self is and who you want to become. How would your best and highest self effortlessly navigate that difficult conversation or situation? Close your eyes, take a few deep breaths then visualize the best possible outcome. Visualize multiple positive outcomes and how your best self would navigate each situation. How would you joyously interact with each person in the room? How do you want each person to feel?

How do you want to feel? If you get tripped up, how would you navigate the situation?

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This takes practice, and it’s not just some newage woo in the world; it’s science2. And if it works for the highest performing individuals in the world, including Olympians and Muhammad Ali3, I think I’ll make it part of my daily habits while on my quest to become the best version of myself.

To me, authentic leadership starts with figuring out who we are by first identifying our boundaries and values. Once we have our inner compass set to guide us along our unique path on this journey we call life, then it doesn’t matter how rough the seas are or how hard it is to see the path, we can trust that we are making the right decisions and effectively leading through these uncertain times.

REFERENCEs 1. Forbes, M. (2019, May 14). Melinda Gates’ Quest To Find Her Voice And Battle Power Inequities At Work And At Home. Retrieved July 15, 2020, from https://www.forbes.com/sites/ moiraforbes/2019/05/14/melinda-gates-quest-tofind-her-voice-and-battle-power-inequities-at-work-andat-home/ 2. LeVan, A. (2009, December 03). Seeing Is Believing: The Power of Visualization.

Retrieved July 15, 2020, from https://www. psychologytoday.com/us/blog/flourish/200912/ seeing-is-believing-the-power-visualization 3. Ambrose. (2016, August 04). The Secret Exercise That Made Muhammad Ali “The Greatest”.

Retrieved July 15, 2020, from https://www. ambrosewb.com/the-secret-exercise-that-made-muhammad-ali-the-greatest/ Dr. Angela Demaree is the CEO and Principal Consultant for PAWS Consulting, a public health and political consulting firm. Angela recently retired as a Major in the United States Army Reserves, is a Certified High Performance CoachTM and the host of Beyond the Stethoscope, the podcast for veterinarians and busy professionals who want actionable, implementable solutions surrounding work-life balance, accomplishing your goals and living your dreams. She spends her free time with her horse, Tommy and teaching her Quaker Parrot the Purdue Fight Song. You can connect with Angela on Twitter and LinkedIn @DemareeDVM.

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Industry News

Photo by Brian Sterrett, AHS Photographer

By Kathryn Primm, DVM, CVPM

O

ne day recently, a tiny black ball of fluff arrived at the Arizona Humane Society. She is one of the over 80,000 lives that have been saved there in the last five years. This precious kitten was not feeling well, so she was examined by the Arizona Humane Society medical team and ushered to their cat isolation area to manage an upper respiratory infection. Upper respiratory infections are common in kittens, but there was something uncommon about this kitten whom the team named Sonnet.

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She had very striking eyes. In fact, her eyes looked almost like broken window panes or like a spider had spun a web in each of her eyes. The shelter photographer, Brian Sterrett, says that Sonnet looked as though she had a “galaxy in her eyes.” She did not seem particularly uncomfortable, but the team was not sure she had full vision, especially in her left eye.

It turned out that Sonnet was affected by an unusual congenital disorder called Persistent Pupillary Membranes (PPM). According to William W. Miller, DVM, MS, DACVO, PPM is a congenital anomaly that has no known genetic predisposition. During development, the pupillary membranes serve as a source of nutrition to the emerging ocular structures. Once the eyes are fully developed, the role of the membranes is over and they usually regress. In some cases, like Sonnet’s, they fail to dissolve like they should and leave behind the remnants of the membrane network.

PPM can occur in other species including humans, dogs, cattle and horses, but it is still unusual.

Although Sonnet would be spayed prior to placement in her permanent home, PPM is not a condition that she would have passed on to her offspring. The condition is not painful for Sonnet, and in some cases, it regresses during the first 6-8 months of life. She is PETVET MAGAZINE

The condition is not painful for Sonnet, and in some cases, it regresses during the first 6-8 months of life. She is six months old now, so we don’t yet know if her “galaxy eyes” will be permanent. six months old now, so we don’t yet know if her “galaxy eyes” will be permanent.

Dr. Miller says that the good news for Sonnet is that PPMs cause few problems unless they are attached to the lens (which could precipitate cataract formation) or attached to the cornea (which could cause a corneal opacity).

After her recovery from the upper respiratory infection and her short stint as a shelter celebrity, Sonnet was placed in an AHS Foster Hero home and was later adopted. She is, by all accounts, a playful and happy kitten, living her best life with her new family.

The Arizona Humane Society in a non-profit organization that takes in the area’s most vulnerable pets. They have a field rescue team that responds to calls for animal rescue and helps animals whose families are facing hardship. All pets adopted through AHS are spayed/neutered, vaccinated, microchipped and receive appropriate veterinary care.

Since AHS is a non-profit organization, they do not get government funding, so their good work depends on donation.

Every pet entering their care requires an average of $1,000 to treat, manage and place in a forever home, so they are always looking for intriguing stories like Sonnet’s to raise awareness of the plights of animals and their efforts to assist them.

Anyone interested in donating can find out more at www.azhumane.org/donate.  Kathryn Primm, DVM, CVPM is the owner and founder of Applebrook Animal Hospital in Ooltewah, Tennessee. She sees patients, manages a busy small animal practice, and enjoys writing for and speaking to veterinary professionals and pet lovers. She has written and contributed content to many outlets, including magazines like Woman’s Day, Prevention and Health as well as veterinary-focused press.

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PETVET TOp 10 1

Looking FOR

Ten things to DO 2 CELEBRATE HALLOWEEN

LOVE?

socially-distanced style by hosting a pet costume party on your social media accounts, or via email, by asking your clients to submit photos of their pets dressed up. Involve your team by letting them choose the winners!

The new Dating App “Tabby” helps cat lovers connect and create purrfect couples. Download it for free today.

3 Aromatherapy

4 TAKE A

has been shown to decrease stress

and increase

TRIP

happiness levels.

Nothing says relaxation like a mini vacation. But, with the pandemic still in full force, make sure to bring your mask and hand sanitizer, and don’t stray too far from home.

Try mixing coconut oil, castile soap, and 4-5 drops of your favorite essential oil and adding it to a hot bath. Close your eyes and enjoy!

5 Cancer Awareness Month November is National Pet

Cancer is the leading disease-related cause of death for domestic dogs and cats in the U.S., so this month, spread the word to help educate pet owners about how best to protect their furry family members.

Illustration by @katemangostar

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this month 6

fall time is the perfect

time to START a

virtually!

a Great book Our choice is Mexican Gothic by Silvia Moreno Garcia, described as a “terrifying twist on classic gothic horror.”

8

If you want to help others but aren’t able to due to coronavirus, try volunteering online. You can offer to tutor someone, FaceTime with the elderly or provide virtual assistance for the blind.

Not comfortable GOING back to the

GYM quite yet?

There are unlimited workouts available on YouTube.

They’re free, and many of them don’t require equipment at all, just a little room to work. We love Rodney Yee yoga classes!

10

7 Volunteer,

you celebrate 9 do wolfenoot?

This viral holiday, invented by a sevenyear-old boy from New Zealand, takes place on November 23rd and is a celebration of canines, kindness and humans who embrace both. To find out how to celebrate or join the Facebook group, search “Wolfenoot Central.”

Look no further than outschool.com for fun remote classes for your kids They have hundreds of exciting classes, from standard math and sciences to art and dance.

Classes start at $8 and are offered with the flexibility that you need with your busy schedule.

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