It’s an inevitable component of the practice of veterinary medicine, and a potential source of anxiety for everyone involved.
As veterinary professionals, many of us get a little nervous talking about prices and going over estimates with our clients.
We brace ourselves for the “you’re only in it for the money” statement we’ve heard so many times before.
It hurts. It’s not true.
But what is true is that we all have our own opinions about the prices that we charge…
… and when we don’t believe in the prices attached to our products and services, then recommending and selling those things feels really icky.
It adds a whole new level of pressure we didn’t expect when we were in school…
A level we’d rather live without.
Because, just like our clients, we have our own financial situations.
We have our own budgets, our own expenses, and our own uncertainties about what things cost.
Also like our clients, we really care about the pets, and we want to help them… and it sucks when money seems to get in the way.
I’ve found one little sentence at the end of a pricing conversation makes all the difference.
It allows clients to physically relax, and veterinary professionals to release the pressure of the decision.
In this episode of the Joyful DVM Podcast, I dig into the three aspects of money that are creating the pressure we feel, and share the one sentence that releases the pressure so we can move forward together with our clients in providing the best care for their pets in the moment.
If this episode hits home for you, please share it with a friend and leave us a review on iTunes or wherever you’re listening.
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This transcript is auto-generated and may contain typos. Hi there. I'm Dr. Cari Wise, veterinarian, certified life coach and certified quantum human design specialist. If you are a veterinary professional looking to uplevel your life and your career or maybe looking to go in an entirely new direction, then what I talk about here on the Joyful DVM podcast is absolutely for you. Let's get started. Hello my friends. Welcome back to another episode of the Joyful DVM podcast. In today's episode, I wanna spend some time talking about money. And this is a topic that when you heard me say the word money, it's quite possible that the hair stood up on the back of the ne or your neck. And maybe you got a little bit uncomfortable or maybe you got a little bit excited because you're interested to hear what I have to say about this topic. Well, today in this episode, I wanna talk about money from three different perspectives. I wanna consider money from the angle of a veterinarian trying to earn a living. So money that we charge within our veterinary hospitals from the aspect of a veterinarian, from a personal life, so our own debt, student loans, making those kinds of payments, trying to earn a living to sustain our lifestyle. And then also from the perspective of the pet parent from the client, which is something that has been really front and center in my awareness lately as I have been back enjoying some practice of veterinary medicine in the clinical setting as of late. So let's start. Where do we wanna start? If we start thinking about money? Most of the time in veterinary medicine when we are talking about money, particularly when we are talking about money coupled with talking about veterinary practice, we're having conversations about clients who are unhappy about spending money and we're discussing among ourselves the way that they interact with us about the money. So they decline services, they say it's because of the money, which it very well might be. But then we also tend to take that very personally. Of course we do because we've had a lot of experiences. Almost every one of us probably can remember a time when somebody, a client who was frustrated about prices, said something to us like, you don't care about animals, you're only in it for the money. And that stings a lot, right? It hurts at our core because we know that that's not true. Recently, as I have been back in clinical practice helping out at a veterinary hospital, what I have really seen in my conversations with money are a few different things, but I've also been approaching it in a much different way. I have not yet had that said to me that that you're only in it for the money statement, though. You know, we do this long enough, it's going to be said. And so it's been said to me before in the past, so I have every reason to believe that it's possible that it will be said to me again. But there are things that clients have been declining because of the cost of the services. Now, what's interesting about this is that is my reaction to it because for me this time around, it's completely neutral. It's been a really fascinating thing to watch on both sides, both my reaction to it and also the way that the client communicates. What I found is there's some things that I can do during those conversations to make the money conversation easier for all of us. In order for us to be able to do that though, we have to be very solid in our own money story. And so what that means is that we have to know for ourselves what we believe about our prices and about the services that we provide. We also have to know for ourselves how we feel about asking for money in exchange for our services. Are we confident in our own skills and knowledge? And in addition to that, if we're putting ourselves in the pet owner's shoes, are we staying out of judgment when they make their decisions? This gets to be a little bit tricky because many of us work for organizations that track the amount of money that we bring in, and that's okay. Honestly, it's okay if the amount of money that we produce is something that is tracked because these are businesses and there are metrics that help us to determine whether or not a business is healthy that help us to identify opportunities for growth. Also helps us to identify opportunities to grow our teams so that we can provide more services to more people. We have to take a look at the metrics, but in our culture, as soon as we take a look at money and we start talking about money, everybody gets weird and uncomfortable. And I'm gonna put myself right there into that camp because for years and years and years, I was absolutely one of those people that felt very uncomfortable when anybody wanted to talk about money. And every time that I needed to spend money with whether I was taking my own animal to a specialist or I was going to the dentist or whatever it was, there was some nervousness there because I didn't know exactly what I was getting myself into as far as costs. And hopefully, and usually, typically at some point along those visits, there would be an estimate provided to me and I could make some decisions. But along with those estimates often came a lot of pressure. And so this is where as veterinary professionals, if we already feel a lot of pressure to spend money or a lot of pressure to charge for certain things, then we can go into these conversations with our clients in a negative energy and an energy that is kind of fueled with anxiety. We anticipate that they're going to react badly, that they're gonna decline, and we forget that our job is simply to provide them the options and let them to make the decisions for themselves. That's complicated. When we work in situations where the way that we are paid is in part determined by the amount of money that we bring in, or at least we make it complicated, I don't actually think that it is complicated. I think that when it all comes down to it, as long as we practice good medicine, the money takes care of itself. That means that we practice the medicine the way that we wanna practice. This is the practice of veterinary medicine. After all, it's not the perfection of veterinary medicine. And so the recommendations that we make for our patients are typically bound within our own morals, ethics, and values. If we are giving into pressure to charge for unnecessary tests or to do unnecessary services, then that of course is going to make us feel uncomfortable. But my experience has been that that is often and just almost never the case. Now, I know some of you out there may have a very, very different experience. And if that is you, if you're in an experience where you are being, I wanna use the word forced, that's a pretty heavy handed word, but some of you may really feel like you're being forced to recommend things that you don't think are necessary that I want you to consider for yourself whether or not that particular position is causing you to be out of alignment with your own morals, ethics and values. Because as you've heard me say before, anytime we're in a situation where our morals, ethics, and values are required to be compromised in order to stay there, there's often a really bad fit there. It's a good opportunity for us to start to look for something else when we're wondering whether or not we are in that kind of situation. If we feel uncomfortable charging for things, I want you to take one more step back away from it and ask yourself, why do you think that this is not an appropriate thing to suggest? I'm gonna give you a couple of really tangible examples of things that you might feel uncomfortable including in a treatment plan. And then I want you to consider why. Why would you be uncomfortable doing that? So for example, let's say that you're getting ready to do a surgery and you're doing a surgery estimate and you've been asked to include a nail trim on the surgery estimate. Remember, an estimate is simply an estimate. Clients can decline different aspects of it, and probably your hospital has things that are just non-negotiables for me, non-negotiables or things like pre-anesthetic lab work and pain medication and pain medication to go home. They don't get to decline those. If they wanna decline those things, then they're declining the entire surgery. We're just not gonna do the procedure. But I could put on there something like a nail trim and a microchip and leave that up to them. Now, what would be the upside of including those things? Well, maybe they can't trim their pet's nails at home and we just don't know that. They haven't ever communicated that that's not why they've come in. But they struggle a lot with trimming their nails on their own pet, and so it's going to be asleep and they jump at the chance to have those nails trimmed when their animal is under anesthesia. That's a great value to them and a wonderful service to them. But we wouldn't even know that if we didn't offer it and they wouldn't know that we could do it at that point if we didn't talk about it at some point in that entire cycle. Same thing with the microchip. Maybe somebody's been wanting to get their pet microchip for a long time, but they've seen how big that needle is and because they have their own story and their own history with big needles, they just don't wanna put their pet through that. They think it's this big deal, but it never could occur to them that it could be done when it was under anesthesia for something else. So these little things that we could get into our own head and we could say, oh, we're just adding on a stacking on prices padding the bill, we could talk about it in that way or we could just let it be what it is, which is an opportunity for a client to get an additional service that they may not have even considered could be done at the same time, but that they also have at a 100% opportunity to say no, simply including it as part of a treatment plan and letting them decline. It isn't bad medicine and quite the opposite for those who jump at the chance of it, they are so grateful because many times they haven't even considered to ask about those things because that's usually not why the animal's going under anesthesia in the first place. So that's just a couple of things that's not patting the bill. That's simply being aware of ancillary services that would be of benefit to a patient in a way, being able to provide that in a way that's really convenient for everybody. That's just a couple of examples of where we can get all caught up in our own story. When we're putting together pricing, we always tend to look at the creation of our estimates through our own belief system about the items on there and the prices on those items. And this is what comes to that part about being comfortable with what you charge. Are you comfortable with what is charged for different services and different aspects of services at the place that you work? If you're not, then why are you believing it's too much? What do you think that it should be? Give yourself an opportunity to look at the numbers, look at the data, understand the pricing. What most of us do is we see a number, we draw a conclusion that that's too much and we forget that the whole idea of too much or too little is simply subjective. It's all individual opinion based on individual situation. And believe me, what I think is high today is drastically different than what I thought was high 20 years ago. And that's just because I'm at a different place in my life right now. The same thing for our clients. We have to be able to, I don't wanna say justify our prices, but at least be comfortable for our prices. And the truth of it is that pricing isn't typically, ans isn't typically arbitrary, is it? It's, there's a usually a mathematical equation that goes into pricing, anything. So when we work for organizations as an associate, as associates, this is one area that we have a lot of opportunity to just gain more information to understand why things are priced the way they are. Because if we've never been anything but an associate and have never been on the owner's side of any of these hospitals, then we don't know how the price is getting created. And it's easy for us, especially when we are younger, newer in our professions with a high amount of student loan debt and the lowest salaries that we're probably ever going to make, it's easy for us to look at those prices and say, wow, that's too high. But we don't have anything to compare it against. We haven't ever actually looked at what it costs to run these hospitals. And we know that in this day and age pricing is going up. So before we pass too much judgment on the prices that our hospitals are asking us to charge, perhaps we just need to gain a little bit more on information so we can understand where those numbers come from. And if we're not brave enough to talk to our hospital ownership about those things, there's certainly a lot of information out there on veterinary pricing that's available to every veterinary professional. So you can do a little research on what a standard and you can do a little bit of your own research on what the price of things are, what, what things cost, just to get a better understanding of how those numbers came to be. When you can understand when they came from, it's often a lot easier to talk about them. And so that's important. We get don't want our own money story to get in the way of the services that we're recommending for our clients. Remember, we're the advocate. We're always gonna offer gold standard. At least that's what I recommend. I always recommend Gold Standard and then I let the client decline the things they don't wanna do. The way that I have been talking to clients about money and about the different things that are gonna show up on a treatment plan has really created a, a comfortable pathway for them to decide what they want to do and what they don't want to do today. And I wanted to share that with you because I think it's in a very important aspect of the veterinary care cycle. The way that we talk about money, it's really awkward for everybody when somebody just runs in with an estimate and just has all these line items on there without any, with prices on it, the owner doesn't understand what it is. And maybe an assistant or reception is like, this is what Dr. Wises recommends without any information or ability to answer questions. And then there's the pressure that the client feels, we know they feel pressure when they're presented with that list of prices. How do we know this? Because we feel pressure when we are provided with an estimate as well. Have you ever taken your dog, your dog or your cat to a specialist or to another veterinary clinic? It's the same kind of thing. You feel a little nervous until you get that estimate. And even when you get that estimate, you might still feel a little bit nervous 'cause you had no idea what it was gonna be. And then whatever that dollar amount is, maybe it's outside of what your budget is. So we just wanna remember that clients also live their lives with their own money stories. They have their own budgets, they have their own amount of money that they can spend on their pets. And if we can help them to understand why we're recommending the things that we're recommending, and also give them permission to decline the things that they don't want to do that day, I think that that really strengthens the trust between the client and the veterinary hospital. Those people will remember what you've said. They will come back, they will do what they can for their pets and they will remember that you didn't make them feel bad, you didn't judge them, you didn't shame them for the things that they declined today. And I think that's so important. So the way that I've been approaching my appointments these days is I've been one of the first ones to go in the room instead of one of the second or thirds. I've been trying to maximize our time, maximize our efficiencies, and I find a million people asking the same history questions and subjective questions doesn't really keep the ball rolling at the pace that I like. Now, this is the practice of veterinary medicine. We all get to do it the way that we wanna do it. But what I'm finding works really, really well for me is once my client is in a room with the patient, I'm usually the first one that goes in after that. I'm gonna go in, I'm gonna talk to the client. As I'm talking to the client, I'm, I'm going getting a that subjective history and a subjective evaluation. I'm also looking at the animal. I'm doing my physical exam. I'm talking through what it is that I'm finding with that pet and I may not be able to to do the entire physical exam at that point in time. It's most of the time I'm not gonna be able to take a temperature by myself, you know, and depending on the temperament of the animal, there's maybe things I can't do at all. But what I can do is make that connection with the client, find out exactly why they're there, what are they concerned about, what brought them here today? And as I talk to them and I get that history and I ask those questions, then I can come up with a plan on what I wanna offer them. That plan. I can initialize the conversation right there before I ever leave the room. I can talk to 'em. I'm gonna say, okay, I'm gonna sneak outta here. I'm gonna put together a treatment plan with prices for fluffy today. Here are the things that we talked about that that you're concerned about. You're concerned because he has been having intermittent diarrhea that doesn't appear to be associated with any kind of diet change. You no predictability to it whatsoever. And sometimes it's just 24 hours, sometimes it goes for several days. And as he's gotten older, you've also noticed that he's lost some weight. And I can see here by looking at his medical record that he has lost some weight from the weight that you had previously. So we're curious about that. We wanna investigate that. But you're also interested, you recognize that his vaccines are not up to date and you're wondering about getting those done. Well, I'm gonna tell you right off the bat, I'm probably gonna hold off on the vaccines because I wanna investigate this a little bit further. A little bit of intermittent diarrhea in and of itself, not necessarily something that I freak out about. However, in an animal that's getting older that's also losing weight, I think we need to look a little bit further. So what I'm gonna put on is treatment plan for today is not only a stool check, but then also some senior blood work so we can get a look at what's going on with his organ function to see if there's anything else going on. Once we get that information, then we'll know whether or not we feel safe vaccinating him today. Right now, without that information, I don't feel comfortable taxing his immune system with vaccines. And I'll be making a note of that in his chart. So now at this point, a lot of the time, you know the, the clients as I'm talking through this, they might be getting like these really big eyes, right? They might be getting a little bit nervous. And this is particularly true of a client who has very limited funds. I note that, but I don't alter my plan because of it. But what I do say is this, that I'm gonna sneak outta here, I'm gonna put together that treatment plan with pricing and then you can choose the things that you want to do today. I always end with saying that. Then you get to choose the things that you want to do. Today I go through, I talk about the things I'm gonna put on the plan. And it may be when I get out of the room, like if that was my conversation with the client and I stepped outta the room to put that treatment plan together, I'd be like, dang it, I forgot to put on there what medication I suspect I might use given the results. You know, I'm gonna make my best guess or at least put a range of medication or something. Maybe I was thinking I was gonna give it subq fluid, something like that. Whatever I was thinking I might do treatment-wise, I'm gonna add to that. And then when my assistant goes back in and goes over that estimate with the client and goes through it line by line, 'cause I created the treatment plan and then I spent the time with my assistant to go through line by line what it is. Then when my, my assistant goes in and goes over it with them, it's not the first time that they've heard these things. It's not the first time they've heard the word blood work and they understand a little bit more. Why? Because I've already explained it to 'em once and then my, my assistant's gonna tell them again. They're gonna understand why on the stool sample once, check the stool sample, we're gonna look for parasites, we're gonna look for signs of infection, those kinds of things. And so I've talked about that as I'm telling them in the, I'm going through my physical exam and as I'm telling them what they can anticipate on this treatment plan and why, so I've planted the seeds for them to understand, but then still finished it up with, then you get to decide what you want to do today. I think this is so important because many times we forget to include that piece. And the truth is we all operate that way. We all just do the things that the owner decides that they want to do. But rather than let them tell us no, many of us are trying to guess in advance what is it that they're gonna agree to? And we just never know. My friends, that is such a, a useless, useless waste of time to try to guess what your clients are going to agree to. It can be very frustrating in that moment to try to guess. And when you've really worked hard to try to guess at what they'll approve and then they decline it anyway, then you can be extra frustrated about that. But it's not necessary. Just put on there what you think the pet needs preface it with. They get to decide what they wanna do, talk to the owner as you're getting ready to put your treatment plan together so that they understand what's gonna be on there. Or if you don't have, if you need a minute to like collect your thoughts before you tell them anything specifically, that's okay. Just make sure that you tell your assistant or your technician that you go through with them what every line item means so that they can explain why it is that you put it on there and then just let them decide and move forward from there. As I have been doing more and more of this and adding on, I've always done the other part where I've talked about in advance what I'm gonna put on the treatment plan. But as I've been adding in that extra line and then you get to decide what you want to do today, I see my clients physically relax, I see their shoulders drop, I see them take a deep breath and I see them look grateful. Like that is the only term that I can come up with to if I was gonna guess what emotion they're feeling, I feel I see that word that like they just look grateful that they get to choose. I can see in that moment how much anxiety they've been carrying, how much fear they've been about what that veterinary bill's gonna look like. And when I take the time to talk to them in the room to get the history, to do the physical exam, to make a plan, to explain why I wanna do the things that I wanna do, they understand through that conversation how much I do care about them and I do care about their pet. And when I put together that plan, even just outline it verbally to them and then follow it up, we'll proceed with what you want to do. That puts that power back in their control. I hand the reins back to them, I've done my part, I've evaluated, I've made an assessment, I've come up with a plan, I've communicated that with them, and then they get to decide and I'm saying, Hey, this is yours to decide. I will help you in whatever way you wanna be helped. And if they decide they wanna decline most of the things and just go conservative, that's completely fine, then that is what we are gonna do. I just make sure that in that case, especially if it's a case that I'm worried about that patient outcome, that I communicate that with them. This is conservative treatment. I'm worried that there may be some other underlying things, but I totally understand. Let's give it a shot if we can. Conservatives within your budget today, let's see, it might be enough, but if it's not, you've got an idea of what we're gonna need to do next to get to the bottom of this. I don't judge them in advance. I let them decide it is their choice, it is their money, it is their pet. It's not mine to decide, it's mine to offer them what it is that I recommend that they do. But once they decide I don't need to judge them because the moment that I judge them or shame them, then I've lost their trust, then I've lost the opportunity to help that pet at all. And I've created a really uncomfortable situation for all of us. And in that moment, I also forget that all judgment is self-judgment. That whenever we judge somebody else, it's not about them, it's about us. And it's about our fear about what they've decided, afraid that that pet's not gonna get better. And believing that we are responsible for getting better or not. We've stepped outside of our lane into things that we will never control. So these money conversations, they can have a lot of power behind them, a lot of emotional density to them. I get that. But those three different aspects of money all play into those conversations that we have with clients. So not only their own budget and what they're able to do, which is their decision, but then also our beliefs about the prices that we charge and also our beliefs about our own money situation and our income and our and our own debt. Those three things, our personal money story, our work money story, and our client money story all play together to influence the way that we talk to our clients. If we can step back and first separate those things out and clean them up a bit, let the client money story be something that we don't even try to predict because it's not ours to, to manage our role only with the client is to provide options and let them decide and then move forward with the, with the practice money story, with our professional, you know, clinic money story, if you will. If we're really uncomfortable with our prices, we need to gather some more information so that we can either feel comfortable talking about the things that we recommend or we can move on to someplace that's more aligned with what we believe the prices should be. We don't need to judge or get angry at the clinics that we work at for the what they charge. There's a reason that they charge those things. And hopefully you are in a situation where you can ask the questions and you can get an answer. If not, like I told you, you can do some research and get some general idea for veterinary pricing in 2023. But aside from that, if it just isn't aligned with your own morals, ethics, and values, then perhaps that place that you work isn't a right fit. Because the last thing that you wanna do is to continue to try to recommend services and treatments. If you absolutely don't agree with the prices, one of the ways that you'll know this is if you hear yourself say, I would never bring my pet here because it's too expensive. If that's you, then we need to take a look at the overall fit of that job because it's gonna be really challenging for you to be confident in what you recommend. If underneath it you don't actually believe in what you're recommending. It's a really interesting place to be. I think that we all have to consider that and how that influences the way we talk to our clients. And finally, our own money story. What do we believe about debt? What do we believe about income? What do we believe about the wages that we're making right now? What do we believe about our income potential? Our own money story has a huge influence on the way that we look at the pricing in our veterinary clinics and the way that we talk to our clients about the treatments that we recommend and what we even put on those plans. And we cannot bring our own money story into these conversations because that's what has us trying to predict in advance what they're going to agree to. That's what has us trying to put only things on there that we think that they're gonna say yes to, because we think that that somehow protects us from them saying no, or for them saying no in an ugly way. We forget that we're never gonna control those things. No matter how much effort you put into putting an estimate together, that is exactly what you think they're gonna agree to, you're never gonna control their reaction to that. People who you believe have the means are going to say no. And they might say no in a really snarky way. And people who you believe that there's no way that they're gonna say yes will say yes to all of it and have a surplus for the whatever you need to do next, doc. So don't worry about that stuff. It's not yours to worry about. It's just simply their decisions. Your only job is to make the recommendations and when you can make the recommendations from a clean place, from a place of advocacy by looking. And what I mean by that is by looking at the patient in front of you and deciding, what do I believe that this patient needs right now? What information do I need to gather in order to understand what's going on with this patient medically? What tests do I need to gather that information? What treatment do I think might be next? And we don't have a crystal ball sometimes we're just gonna give them a diagnostics only estimate because we don't know what's going on. I've done so many of those. I don't know what's wrong with your pet. Something is wrong. Here's the things that are abnormal in physical exam, but I haven't yet concluded how these things are all tied together. I need some information. So I need to do some diagnostic testing. I need to run some blood work. I need to get some x-rays. I need to do special test A, B, and C. And then once I have that information, then I'm gonna know better how to move forward. Sometimes that's where we start my friends, you're not supposed to have the diagnosis before you ever do the the diagnostic tests. I wanna say that again. You're not supposed to have the diagnosis before you ever do the diagnostic test. That's okay. It's okay to do a multi-phase estimate to let people know this is a diagnostic only treatment plan, estimate plan, I guess you would call it investigative plan. And then once we have this information, then I'm gonna make a recommendation on what we may do next. And it might include these things. And you can put those on there as a range. You can talk about them without them being firm. Don't be afraid to advocate for the patient and don't, don't be afraid to just say, you know what? I don't know until I get more information. Because this is the practice of veterinary medicine. We do work with patients that cannot talk to us. And until we get the information we need, it's very, very difficult for us to draw conclusions and to make a diagnosis. And that is nothing to be ashamed about. And the fact that those diagnostic tests cost money to run that is just the way the world works. They're not free. You know, they're not free. So we can recommend them and let the owner decide whether or not they wanna invest in those things. But do not feel bad about what you, you recommend if you know that that's the information that you need to be able to, to help that pet and the great to the greatest of your ability. That is just simply the practice of veterinary medicine. Advocate for the pet. Put on that plan what you think that that pet needs. Let the owner decide and then move forward. Cheerfully. Don't be resentful, don't be angry. Don't be frustrated. Don't get stuck in a cycle. If, if I only had those results, then I would know what was wrong with this pet because it happens to all of us. They say no, initially we treat conservatively, don't, they don't get better. Then we go to the next step. We, we get more aggressive with their diagnostics because at this point, the owner says yes to something that before they said no to. And maybe at that point, we believe once we get those test results back, that it's, it's gotten so much worse that the chances of that animal responding are worse now three days later than they were three days before. Maybe that's true, maybe it's not true. But being angry about that isn't anything that's gonna help you or the pet. It just is what it is. The client got to decide the path forward, the the speed of the path forward. You always just provided the path. That's okay. You'll help them wherever they are on that path at any given point in time, even though they're the ones who get to pick the pace. That's not a problem. It only becomes a problem if you tie your value to whether or not that patient responds positively. My friends, that is not yours to control, no matter what speed they go on that path. Patient outcomes are something that you will never control. You'll influence 'em a tiny little bit, but you will never control them. And so as soon as you can start to release patients who get better and clients who are happy from your criteria of success, the sooner that you're gonna take that pressure off of yourself. And when you do that, these money stories also get a whole lot easier. So just some food for thought for you this week as you go into your week, thinking about your own money situation, thinking about the pricing at your hospitals and going into those conversations with clients about money. Hopefully this helps to take the pressure off just a little bit. If this episode resonated with you, I do hope that you will share it with a friend and jump over to iTunes and give us a review that's always helpful in growing our audience and helping more veterinary professionals over here at Joyful DVM. That's gonna wrap it up for this week. Bye for now.