Bridging Medicine and Veterinary Care: Insights from Dr. Eve Harrison, DVM

In this episode of the My DPC Story podcast, host Maryal Conception interviews Dr. Eve Harrison, a concierge, cash-based, house call Veterinarian based in Los Angeles. Dr. Harrison shares her journey from traditional veterinary training, including her struggles with the corporatized veterinary system (you'll be amazed at the similarities in the human world), to establishing her own integrative and concierge veterinary practice. Throughout the discussion, they draw parallels between human medicine and veterinary care, highlighting the challenges posed by corporate influences in both fields. Listeners gain insights into the importance of establishing long-term relationships with patients, managing holistic care, and the impact of corporate healthcare on both human and animal patients. Dr. Harrison's story sheds light on the shared struggles and the innovative paths taken by healthcare practitioners in providing compassionate and personalized care.

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Transcript

Maryal Concepcion: 1:16

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Conception. Family, physician, DPC, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.

Eve Harrison, DVM: 2:05

The similarities between human medicine and veterinary medicine are so uncanny. It's kind of crazy that we don't learn more from each other on the regular. I'm Dr. Eve Harrison with Marigold Veterinary and the house called Vet Academy, and this is my direct veterinary story.

Maryal Concepcion: 2:24

Dr. Eve Harrison graduated from the University of Pennsylvania School of Veterinary Medicine and then went on to do an internship in medicine, surgery, cardiology, emergency medicine, and the health of exotic animals in San Diego before going to a surgical residency in the Bay Area before changing paths completely to be a full-time integrative, concierge house call veterinarian in the Los Angeles area. She's also certified in traditional Chinese veterinary medicine from the Chi Institute. Her work outside. Of clinical veterinary practice focuses on grassroots efforts and solidarity in protecting independent veterinary practice ownership. In light of the corporate takeover of veterinary medicine and empowering individual veterinarians, he is a speaker writer, content creator, and the founder of the online Continuing Education course, the House called that Academy. Through the academy, she offers coaching and consulting to help independent veterinarians nourish not only their patients but themselves by helping them to cultivate profitable and sustainable mobile. Of their own. She's also the founder of the Annual House call and Mobile Vet Virtual Conference. Host of the house call Vet Cafe Podcast Concierge, vet Mastermind, and Soul Shine Spice for vet. Dr. Eve's passions are creative entrepreneurship, veterinary practice management, sustainability for veterinarians, boundaries, authentic communication, and releasing people in systems who are not a good match for our practices. Or our lives outside of her work with animals and their humans. Dr. Eve is a semi-professional musician, Flo Yogi MyFi, and a certified compassion fatigue professional. Welcome to the podcast, Dr. Eve.

Eve Harrison, DVM: 4:01

Ah, thank you so much for having me. I am just like really excited and have been looking forward to this call for a while.'cause you've been on my podcast. It was one of my most beloved episodes and so yay. What an honor to be on your show too. Thank you so much for having me.

Maryal Concepcion: 4:16

Absolutely. And. Yes, you did hear right. In terms of Dr. Eve's bio, she is a veterinarian, meaning we only take care of the human species and she takes care of all the other species. And I, I just wanna put for the audience a little, intro to this whole conversation. Dr. Eve and I met at the Take Medicine back conference back in, maybe the spring of 2024. Take medicine back as an organization, really focused on taking medicine back into the hands of physicians and their patients and away from the corporate practice of medicine. And so what I was just floored by was the similarities between the human side of things as well as the non-human side of things. And so that is why I've asked Dr. Eve to come onto the podcast to share her perspective, because I think it's very eye-opening, not only for us as physicians who are listening out there, but also for anybody who is interested in, where healthcare is today for human and non-human species. And so I'm excited about this conversation as well. And, I hope that it is eye-opening and I hope you share this episode with other people, because it does not matter what type of corporate medicine you're doing. Corporate medicine is corporate medicine.

Eve Harrison, DVM: 5:27

Yeah, absolutely. Yeah. And if you hadn't mentioned the Take Medicine Back conference, I was gonna, because it was revolutionary.

Maryal Concepcion: 5:34

Absolutely. So let's talk about when it comes to when it comes to your background in veterinary medicine, we hear every week from human physicians in terms of their, training after school, basically. So tell us in terms of a veterinarian's path after school what is your guys' training like, what is the expectation like, and how many of veterinary, how many veterinary grads go into employed medicine versus independent medicine? I.

Eve Harrison, DVM: 6:10

Great questions. So there, there are definitely some, there, there's tremendous amounts of similarities. Like we have the match system and everything. We're not quite as what, what I believe is sort of maybe more regimented in the human medical system. Like my sister is a do. So I watched her go through that process. My little sister's a pa so I, I know about that as well to some extent. But it seems that in veterinary medicine, you could do an internship, you could do a residency, pretty rare in general to be residency trained. Whereas I understand in human medicine it's, required but for us, it's very much like, if you want to be a surgeon or you want to be an internal medicine specialist, or you want to be a neurologist, you, you have to go internship and then residency, usually the internships are one year general rotating internships followed by potentially. If it's a really difficult residency program to get into, sometimes there's specialty residencies. That's another year or multiple years until you get into the residency program of your choice. For me I, I sort of like took the express path, like unbeknownst to me and undesirable to me in retrospect. So I, I knew I wanted an internship. Personally, I, I, I'd heard from many people, like it's really good to have, formal mentorship and go a little bit deeper into each of these subjects, which, if you end up just going general practice, which is kind of the default for small animal veterinarians. Mm-hmm. So small animal being dog, cat, maybe what we call an exotic or two, maybe a rabbit, maybe a hamster. But usually like the default for veterinarians, general practice, cat and dog. Even if you wanted to kind of go into general practice without any sort of specialty, the word on the streets is it's really nice to have an internship so that there can be a little bit of handholding. You can go a little bit deeper into internal medicine, a little bit deeper into surgery. General practitioners in veterinary medicine are doing all of it. Surgery, neurology, literally every, it's insane when I compare what vets do to what my sisters do on, on a, like a general medicine basis, I'm just like, We have to do surgery, we have to do endoscopy, we have to do all this crazy mri, but anyway, so, the, the path that I took was I did my four year veterinary training. Well, we, okay, so pre, pre-med is the same as pre-vet, essentially, so I'm going way back. Right. So then you do your four year veterinary training. You can either go the path of internship plus minus residency or just go straight into general practice. I would say the majority of people go generally into general practice. And then, I really don't know. I'm pulling numbers out of. Out of thin air, but in my observation, it seems maybe 50% of people do an internship, maybe 30%, and then maybe 10, five to 10% go on to specialize that. That's kind of my, my image of it. But don't, don't quote me on that. I, I haven't looked at any studies on that specifically, but that's my general impression. And for me, I did my, my general rotating internship. I had an inkling I wanted to be a surgeon. Maybe I like working with my hands. I like fixing things. Yeah, I don't know. My, I have a, a medical family and, and we are, or adjacent, I grew up visiting the, or many times, so I thought maybe I wanted to be a veterinary surgeon. And I'd also done some surgery. Sort of like volunteer work on Native American reservations in vet school. And I really liked the surgical aspect and it, it, it became clear that you better know how to do surgery really well. So I thought I wanted to be a board certified surgeon to really get all that training. So I did my general internship. I applied for residency. Miraculously I got in, I thought it was gonna take me multiple years as is the case with most people going that path. But for some reason I matched right out of internship to my shock horror imposter syndrome self. I was just like, oh my God. So there was a, a bit of a, a shock there. And it didn't work out. So, I did a few years of that and then shifted to a totally different direction. So that's kind of a little bit of my story embedded in the general veterinary path story,

Maryal Concepcion: 10:18

tell us when it comes to the similarities between the, the practice of medicine, I'm just wondering if you even saw along your journey changes such that things were becoming more corporatized, and if so, what did you see?

Eve Harrison, DVM: 10:34

Yeah, so I, I always kind of say that in, in my observation, it seems like the veterinary profession is maybe like 10 to 20 years behind the human medical field in terms of the corporatization process. This is just my, my intuitive sense, having seen a little bit of both While I was in vet school, I was feeling a lot of corporate pressure to join a corporate internship. We got talks from the corporate entities saying things like, if you don't do an internship, you're gonna be a bad vet. In fact, you, if you don't do our internship, you're gonna be a bad vet. I remember things like that. I can't speak to how it was before I joined the profession, but all of my experiences as a vet tech before I, or a vet assistant to, to be more precise in the, the language in independent practices. I, I'd never seen anything like this and I had been prepping to be in vet school for maybe 10 years prior or more. So I, I was seeing only independent. And then when, when I got to vet school, there was a very heavy influence from the the corporate companies coming in, giving us lunch talks, telling us about their programs and why, why we would be inferior if we didn't join their programs, you know what I mean? So in vet school was the first time I saw it. I, I graduated about 13 years ago. But I, I know that the corporatization of human medicine has been going on far, far beyond that, that period of time, I, I, my family would talk about it. I would Just like out in the ether, my friends who became doctors, I heard about it as well. So this was the veterinary exposure that I got once I got into vet school,

Maryal Concepcion: 12:09

and

Eve Harrison, DVM: 12:09

I did a corporate internship. I did a corporate residency miserable. I, I was absolutely miserable. Like for the first time in my life, I, I'm very open about it. I had to go on antidepressants and I've never come off, you know, and, that's, that's a subject for another time. But like the damage done in, in those few years to try and survive in what my profession portrayed to be, the path to being a good doctor. The, the path to being worthy in the corporate paradigm I'm still recovering to this day, to be honest, you know,

Maryal Concepcion: 12:48

and I appreciate that vulnerability because, it's it's something so relatable to our listeners out there. I'm wondering if even just breaking down when it, it comes to. This place that was the corporate experience that you had? I think about in the human world, we after we get our golden handcuffs, we go to an employed position, we get our magical salary, and then all of a sudden your, your feet are wet, the water's warm, and now they're like, boom. RVs. Very commonly the human side of things is very much based on productivity. I love how productivity is, how to describe human medicine. But in the vet world were you, in residency or just, in general for somebody who is practicing in a corporate model can you speak to us about is there a productivity equivalent

Eve Harrison, DVM: 13:35

there absolutely is. The good thing is I was never put under productivity pressure as an intern or resident. I believe my mentors were in, in that scenario. I, I can't speak a hundred percent to that. But I I've not experienced productivity other than one time in a corporate practice while I was doing relief work or moonlighting work as I think you guys are more inclined to call it. More of the productivity pressure I've heard comes from people who are associates at corporate practices, associates at corporate house call practices you have to meet certain amounts of seeing patients or. You will get spoken to, or you, you won't get the, the full pay that you need to make in order for this job to be worth it. Right? Like, they'll say, oh, well, you'll get a bonus. But it's like, if you don't make that bonus, then you're living on an income that is unrealistic for, for someone trying to work at this capacity. You know what I mean? I would say I've, I've been very lucky that I've, like, I learned what corporate is. I learned that I don't fit into that type of hierarchical system um, that has pressures. I luckily, I was shielded from those pressures in my training. But the environments that I was in, the way I was learning, the way patients were treated, the way my clinical intuition was. Like devalued. And, something other maybe money or bottom line, something else other than what my clinical impression was, my care for the patient was being put above that. It was very, very clear. But, as a result of that, I, I sort of like immediately was like, I cannot work in these environments. And so by the time I was, not a resident or intern, I was like, yeah, I'm not gonna subject myself to that. So all of the horror stories are my colleagues, my friends things that I've seen and or been offered and been like, no, thank you. You know what I mean? So thankfully I haven't been like under the productivity hammer myself, thank God.

Maryal Concepcion: 18:12

Even though you weren't necessarily under the productivity model equivalent as a, you know, a person who's been working in the system for. Maybe two years, three years, sometimes the RVU go in, depending on the contract sooner than that. Yeah. When it comes to, the frustration that humans have with the human medicine system, I'm wondering, can you talk to us about the, the patient side of things? Because, I think about, especially if you're dealing with domestic animals, which is, the most common thing that we see veterinary visits for. There's a lot of corporate vet clinics and you're delivering a completely different model. And I'm just wondering, like, can you speak to experiences that a person might typically expect to have? What's the visit time like? What's an appropriate time like for, a, a general checkup versus something acute that could happen with a cat or a dog?

Eve Harrison, DVM: 19:05

I mean, Even outside of the productivity model of, of incentivizing or de incentivizing people based on their behavior around productivity, the time slots in most corporate and, and also some independent clinic settings, which I think is a derivative of the corporate mindset that we've been indoctrinated with. One way that that sort of can also play out is with either 15 minute appointments or 20 minute appointments or 30 minute appointments. I don't think any of those are generally enough time to handle anything that really matters. I've done relief work and as I mentioned in general practice and in corporate, and to me, I, it's, it's like I. Brutal on my nervous system.'cause it's like, well first of all, I'm trained in so much more than, than just like the very, very basics. The more you know, the harder it is to hold an appointment time that is so restrictive where you're like, yeah, we can put a bandaid on this. Or I can really help you and in 15 minutes I really can't help you. So this is painful for everybody. This is a, a very poor setup. I have refused to work in a place that has 15 minute or 20 minute appointments. That's insufficient in, in my opinion. If you're really doing good medicine, you really care. You wanna hear. You wanna give people the, the chance to speak about what's going on about the animal. We're in a situation where animals can't speak, right? So the advocacy of the human on behalf of the animal is even more important. I need to, I need to hear brain dump for me. Tell me what's going on and I'll pick out what I need to know. I'll ask you all the questions. The history alone could take 30 minutes before I examine the animal, before I come up with a treatment plan, let alone enact any of those treatments. Right?

Maryal Concepcion: 20:48

And I'm sure that there are other people out there listening saying, but. Why is she mentioning times longer than the humans get per visit? So also the fact that you're like, I don't take jobs that have shorter than the quote unquote decent time to start with, but it's, it's not even enough. I think very much about like a pediatric patient and, pediatricians especially are really bombarded with like, well child visits and sure you can deal with an ear infection same time, five minutes. Five minutes, it's like it's like an auction and it's like actually, especially when somebody cannot advocate for themselves, it is a lot of times harder to get the history and it takes more time because you. Our thinking from, the shoes of somebody who might be overwhelmed, especially again, going to pediatrics, like multiple children working and a parent. And then, it's like details are not necessarily going to be at the forefront depending on how long it took to get in, depending on how worried the parent is. The listeners can absolutely see similarities there, even just with the frustration of, of time. And I'm wondering in terms of, what does it look like for a person who is going over time? Like, what happens if they're like, Dr. Harrison, you're like 30 minutes behind, you're an hour and a half behind.

Eve Harrison, DVM: 22:03

Oh, I'm so glad you asked that question. I was just like, oh, I just thought of two times that I need to mention. So, one time I was, I was doing my relief work at a corporate practice. I was, 45 minutes behind. This was not entirely my fault. People showed up late and you, if you wanna in accommodate them, you have to, everyone gets shifted, right? You have an appointment that throws a monkey wrench in, in your schedule. You're not expecting some someone to be like literally in an ICU crisis state that you need to now handle that and then move on with it. So there was a, there was a point where I was 45 minutes late and I got a talking to by corporate and I was like, get real, get out of here. Like you have no idea what's happening on the floor right now. You have no idea. Then during my residency, this was one of my favorites. I was working with a cat that had a urinary obstruction. This is something that happens very commonly in male cats. And it's life threatening, of course, right? If you, you can't pee, you can't, you know. so anyway, this was a life and death situation. The animal was very sick. The client was trying to decide whether to euthanize or to proceed with care. I took a long time with this guardian of the cat. And they were really, really going back and forth. You could see that this was like a deeply important. Upsetting moment, and I mean, this is life and death. Like in, in human medicine, it's only very recently that euthanasia or like end of life decisions is even legal at all. This is our every day, right? This is so heavy, and to me, I don't take that lightly and no one takes it lightly, but to me, I, I wear my heart on my sleeve every single euthanasia. I feel that, and I don't want that to change. So I spent a good amount of time with this client. Meanwhile, I had told my staff, please put in an IV catheter, start IV fluids, do basic triage stuff, just stabilize, while I'm having this conversation. And I got them to proceed with care like this is. Not an old cat, like we can save this cat. Like, this is easy if you just let us do it, but it required a conversation, it required a heart to heart. It required me hearing what their concerns were. It required me to, to step almost a little bit outside my role of a veterinarian and just be a human using my communication skills to get to the heart of it. And that's not something you're gonna do in 15 minutes, 30 minutes. I probably was in there for 40 minutes if I had to in and out, just like you think on it, I'll come back. After that, I my mentors were like, you took way too long in there. You endangered the life of this animal. I'm like, do you understand what I was doing? I was saving, literally saving the life of this cat. Without that conversation, without taking the time, the cat would be dead, period. Right. I employed basic triage. Anything further that we needed required the permission, the consent of the client, and I got that. So you're welcome. So that, that was one of my favorite moments of like, this is not. This is not how I want to function in the world. This is not how I doctor, I am sorry. I am not gonna be a cog in this machine. You know what I mean?

Maryal Concepcion: 27:51

Absolutely. And I just, I think about, how many times, especially in family medicine residency, anybody who's right rotated in the ICU or an emergency room, I mean, just the horrific things that we've seen, drowning of little kids people being coated and coated when, that like it's doing more damage to their body. I mean, so many violent and sad things. But, just recently having put our 16-year-old cat down, sorry. Like in, in my experience, we've put an animal down um, and and I cannot imagine, you're, you're an outpatient veterinary doctor and yet you're doing end of life care. I mean, yes, I do, I do care for people in hospice, but like, not at the volume that you guys would do. And so I can't even imagine the the, the, the vast difference in the amount of times your heart is being not only worn on your sleeve, but also just being wronged to like the core because of you being there for your animals. Just the same, like, we're there for our patients.

Eve Harrison, DVM: 29:00

Yeah. Yeah. That's very well said. I think that's one of the. Primary reasons. Just like you said, like the volume of this high intensity emotional content and, and like the work itself. That's why veterinarians have an uncanny rate of suicide. I, I can't be on this show without mentioning it. But it's, it's a real, real problem. There are a lot of studies out there from the American Veterinary Medical Association published in the CDC collaborations that show all these statistics and things, and there's a myriad, myriad numbers of reasons why that is. And I know human doctors and, and caregivers and dentists as well struggle with this. Veterinarians are, are. Kind of the top, the top of that. Not to like, have any trauma Olympics, but it's simply a fact, right? And I think that the, the corporate pressure, the corporate structure, the corporate mindset, even if it's not an actual corporate practice to, to see more and more and more bottom line dehumanize people, dehumanize animals, deani, animalize animals, right? Like objectify get more done productivity, even if you're being paid on a production model or not. That that's, that vibe is still deeply entrenched in the in, in the sort of moia of the work and that. That wears on people. That's, that's moral injury, that's depression, anxiety, loss of meaning, loss of purpose, et cetera. All of that. It's so deep how harmful that is when we can't take the time that is needed for these really heart wrenching difficult, emotionally speaking and, and intellectually, physically difficult cases, so, yeah. And I'm so sorry about your cat. I'm, I'm so sorry to hear that.

Maryal Concepcion: 30:48

Thank you. I think about also, I. When we are talking with people, whether they're speaking for themselves or they're speaking for their loved one who might not be able to speak for themselves for whatever reason. Even just the medical understanding, like taking the time. I, I, and I don't know if this is a thing in veterinary medicine as much as it is in human medicine, but like suspicion about science and vaccines and like, are you really trying to help me or are you just trying to kill my animal because you have somebody in the waiting room, like, I wonder if you can speak to us about just, just the, the, the things you have to do with patients because you are, taking care of, of somebody who is sick and who can't speak English or whatever language the human would speak to each other in a clinic.

Eve Harrison, DVM: 31:33

That's really a really, really interesting point. I, I was speaking to a colleague about the, recently about the fact that this sort of doubting and the skepticism about the veterinary field and, and the medical field, it's, it's a trauma response to what, what has happened, right? Like, we all get annoyed. We're like, oh God, here we go again. Now I have to explain like how life works, how fit science is a thing. Like, all right, here we go. But the thing is like, people have kind of have reason to, to be skeptical. I have reason to be skeptical of my own profession based on what I've been through. So. In my own practice, I am really aware of this phenomenon. I'm really accommodating of it. I almost anticipate it being in integrative medicine where I'm incorporating all the regular Western stuff along with traditional Chinese veterinary medicine holistic paradigms, things like that. Maybe some of it's cutting edge. Some of it is not evidence-based, but anecdotally based. And I've seen it work many times and yet, and I'm like, if it works and doesn't cause any harm, we're doing it. Okay. Like if, as long as the, the guardian is interested in that. But in, in that sort of container, I am really dealing with a lot of people who are very skeptical, like I do in particular attract those people.'cause they're seeking out holistic care. And usually those people are seeking holistic care'cause they've either been burned by the traditional, they have. Know someone who's been burned by the traditional, it didn't work. They were a, a cog in the system themselves. They didn't like how that felt. They felt invalidated, dehumanized uncared about unseen. And so they're, they're coming to me to, in hopes that I can provide something different. And that's my goal to really take my time. I always say that I work on dog and cat time. However long the animal needs, that's how long it's going to take. So it's very much an open container. It's very un, I'm very boundaried, but my time is unbounded. Because you simply cannot quantify the amount of time that a, a body, a living body is going to, what they're going to bring to you, what they're going to need, what the, what the guardian is gonna be going through as they observe this or hold it, or, or we work through what needs to be done. So that's, that's kind of been my answer that I, I just sort of step right out of the box right outta the matrix and I'm like, you will not give me a 30 minute appointment. I'll take how, however long I want with this animal. And I have an ETA window for all my clients. So they're like, they understand like I would do the same for them if I'm late to see them or, on the back end of my ETA window. It's'cause of dog and cat time. And I would show them the same compassion, empathy, and flexibility in their moment of need, you know,

Maryal Concepcion: 34:31

I think here, especially because you are so passionate about empowering other veterinarians, especially to understand your, what you've experienced, to take a zoom out and really be able to craft their own. Veterinary practice, just like we've done in the human space with direct primary care. I'm just wondering if you can tell us even more about your practice because I, I, I, I feel it's very similar in, we have people who are, they have animals. They need somebody to care for these animals, and they're, maybe not used to having a house call a veterinarian, come to their home. How do you even get the word out about, having a practice like this?

Eve Harrison, DVM: 35:18

Thank you for asking about my practice. So, my practice is called Marigold Veterinary, named after my heart, Catt Marigold, who died but was one of my primary inspirations for becoming a vet to begin with. So my practice is named after her. It's a memorial for her. I am a low volume house call practice. I don't typically see more than three to four patients a day. That's even a heavy day for me. When I say that I'm concierge, I am a concierge house call vet. When I say that, it's a little bit different from human concierge. There's a lot more overlap, I believe with DPC as we've talked about. There's, there's some similarity to human concierge, but it's a cross, essentially. It's a cross between DPC and human concierge. So I am. Essentially requiring a membership to be in my practice. And it's a little bit higher than what most DPCs charge, but not as high as what human concierge doctors we're. We're price wise, we're somewhere in the middle as a rule. I mean, I can't speak to every single concierge vet out there. There's only like 10 in the world like that are doing what I consider to be true concierge veterinary medicine. But of those I think we're, our pricing is probably somewhere in between. because I require a membership, I don't have to take as many clients. So like I'm, that, that is what allows me to be low volume. And it also is what allows me to be very, very selective about exactly which clients I. Feel I'm equipped to support I emotionally and from, from a veterinary perspective and who I can sustainably keep in my life for the long term. Like when, when I take on a concierge patient, they stay forever, most of the time. I, I can't guarantee everyone would, but most of the time this is a long-term relationship. So this is what allows me to really cr craft something entirely outside the box. Like I'm not strictly working on a time for money basis, right? It's not that I have to have the animal get sick so that I can go out to get paid. With concierge being on subscription, I'm paid no matter what. And in fact, I'm actually incentivized that my patients are healthy.'cause then I have to go out and they've, they've already, I've already been paid. So it's like, oh God, now I have to go out again. I mean, I don't actually feel that way, but like my goal is for the animal to be healthy and I'm incentivized for that. To occur, from a financial perspective, an energetic perspective it's just very much more aligned on all the levels of caring about my patient, being a business owner, my own energy. All of that is so much more aligned because I don't have to wait for an animal to get sick, for me to be able to earn an income, you know what I mean?

Maryal Concepcion: 38:12

Makes sense to me. I'm just like, wow. Preventative care versus sick care. That's amazing. Yeah. And I'm wondering, as you are describing something very, very similar to DPC in terms of the membership model and whatnot, I'm wondering just dipping back into the, the corporate side of things are there insurance codes, like when I talk about sick care, we'll have like diabetes versus prevented diabetes and we have a code for the diabetes versus we do not ever have a code for prevented something.

Eve Harrison, DVM: 38:42

This is a really interesting subject. I think we're likewise maybe 10 to 20 years behind you guys in terms of the insurance company takeover. So right now in veterinary medicine, people have the option to get insurance. They have a variety of different companies they can choose from. Each company has a different policy, what they will and won't cover, most of them do not cover preventative care, but that's on a, a policy by policy basis. Some of them may, if you get a rider, may include acupuncture or some holistic care, maybe some rehab. But in general primary care, like preventative care not covered. The way it works for us is currently this is, they're trying to change it. They're trying to, they're trying to do to our profession what they've done to yours. Right now the client pays the vet directly and then the client takes I think what you guys would call a super bill and then submits it to insurance. And they may or may not get reimbursed, but the vet is always reimbursed for their services.'cause the client pays directly what is trying to happen. And they have pitched it in so many glamorous ways and tried to make it look like this is for our benefit and how wonderful it's going to be. But we know better. I mean, I know better not all vets know better, right? Which is why we're, we're in danger right now. But what they're trying to do is have direct pay from the insurance to the veterinarian so the client client is not directly pay, so it's not the direct, direct pay that's the whole, that's the whole thing of it. So the vet may or may not get reimbursed for, for what they recommend. And therefore that is, as you guys all know intimately, that is, like a hardcore control on the medicine itself, which nobody but the doctor, the vet and the client or the patient should be involved in medical decision making. What is or is not warranted. Get out of our lives. Do not insert yourself into the medicine. Okay. So that's what they're actually trying to do. We've had a few a few in incidents of that occurring. There was I have a colleague who was working in the ER and the client had that kind of insurance and they had to wait to see if the insurance would approve. Meanwhile, we're in the er, this is urgent, like we need an answer. The client wanted to go for it, but we had to wait to see if the insurance would approve It like, so disgusting to me. Like it was like she reported that it was like very uncomfortable and really just, I. Impeded timely, appropriate care for this animal. And, I mean, here's the thing. Animals like, they're, they're not people. They're, they're very much like children. Like kind of, you made the comparison between pediatrics and veterinary. They eat things off the floor, they eat poison items, they, they jump off things, they fall off. Things like animals are accident prone, they're illness prone inherently, right? So the, the likelihood of an emergency or something really severe happening to any random animal, I believe is higher in general as compared to potentially human patients. Mm-hmm. That's just my, that's my impression. I don't know a hundred percent, haven't done a study on it, but kind of intuitively, again, sort of feels that way to me.

Maryal Concepcion: 42:04

as you are talking about this person and this, this. Prior auth of an actual emergency visit like that is just so bad backwards because, we see the emergency room in the human system being used as the primary care because a person can't get into primary care. And, it, it behooves the system to create a bad experience. And primary care is such that all the codes are coming through the emergency room. But when it comes to other people, especially the people who have leaned in and are looking to you to teach them about like, how do I do this outside of the system? I'm wondering, what are some other maybe not even a canary in the coal mine, maybe like that coal mine is bursting and exploding actively, but like, when your colleagues are reaching out to you to say like, I have seen this, or I cannot do this any longer because of the emotional toll, especially that you guys are putting into it. What do you share with others based on what you've heard and that you use as, look, there is a different way to practice medicine.

Eve Harrison, DVM: 43:10

Yeah, that, that's the heart of everything I do right now. I would say that I speak to probably 50 to a hundred people per month. Every single one of them has these concerns. I can't do this anymore. I can't provide the medicine I want to provide. I'm not good enough. And it's like, no, no, the system is not meant for how you. Your integrity. Actually, it, it shows up in so many ways. This, like this pain imposter syndrome. I'm not good enough. I, I can't care for my animals the way I want. I, I was forced to euthanize more animals than I felt comfortable euthanizing so that I could earn my, bonus or whatever. There, there are companies that, that put that kind of pressure on euthanasia that, that to me is a real dangerous precedent. I don't wanna go too much into it, but that is, when you're dealing with euthanasia, that's a very, very slippery slope when you're putting corporate type pressure on it, when you're putting production pressure on it. So that's one of my, mean that that's something that really has lit a fire under my butt to, to sort of like, look, there's another way. Just like you said, there's another way. We don't have to, we don't have to play by those rules. We're the vet, we own this profession, not them. Okay. Not the shareholders, not the structure that they're trying to put us into and use us as cogs in the machine. I, I say that phrase a lot'cause there's nothing, it's like a assembly line. We're, we're a cog in someone else's masterpiece of what, what kind, what they're trying to create. No, we own our profession. We're smart. We got through vet school, potentially internship, pr, potentially residency. We do surgery. We, we do so many things. You're gonna tell me that running a business is too hard for you now, come on. So I sort of address that, that. People sort of have resistance to the business side, but to me, I think business is, you don't have to be like some MBA, like obsessed with business or like, care about all these KPIs and, and like get into that whole weird world. To me, business and business ownership and practice ownership is simply a vehicle for taking back our power as the incredible doctors that we are. It's simply a tool in which to contain our magic and offer it to the world without a middleman, without someone taking a cut of our pay, without someone interfering with our medicine, without telling someone, telling us how many euthanasias we have to do or should be doing, or pressuring us into things that cause moral injury.

Maryal Concepcion: 46:02

I go back to my initial thought to say, oh my gosh, I would love to have you share your story on our podcast, because even though again, we're, at my DPC story focused on the human side of medicine every week, I think it's just so important to highlight how the, the need to protect the profession of healthcare is universal when it comes to the country that you're practicing in the city, the, the county, the, the species that you are working with. When healthcare is on the table, it cannot be corporatized. It cannot be rushed. It cannot be determined by someone who's actually not the physician and. This is where the similarities are so apparent, and this is where knowledge for me is helping people have more knowledge out there to help protect what we are intentionally protecting by having our practices.

Eve Harrison, DVM: 47:01

I so agree that there, there is sort of protection needed, like we've taken an oath to do no harm, right? To us, our work is sacred. That connection between us and our patient and our client, sacred shareholders, corporate CEOs, they are simply not on that wavelength. They simply have no concept of what that means, right? And so I think that it is incredibly important that we build structures, our own structures to, to shield ourselves, protect ourselves, protect this sacred. That we've taken, it's almost a responsibility that we have on behalf of ourselves and or to advocate on behalf of others who are, are stuck under the thumb of the system and, and can't get out. Like either they've been so emotionally harmed or led to believe they're not good enough or financially trapped with the golden handcuffs, as you mentioned. Right. So I think that protection is so very important. I think also like the nature of our work is that we are not just machines, like we all know this is not just a science, it's art and a science. And when we're working with animals, we're working with their humans. And the emotions are high. I think, to ignore the fact that we are in a position to support people beyond just the care of the patient is to vastly, minimize what the, the job is, what, what the role of a veterinarian is. And I think many systems that try to box us in try to really, narrow the job description and it's like we're holding something really precious. We're, we're working with people in some of the most vulnerable, painful moments of their lives. And I think true medicine, I think this applies for what you do as well. Like you're holding people in terrible diagnoses or, or the treatment didn't work or they're in literal chronic physical pain all the time. They're not okay. That I think true medicine has, has got to address and see the individual beyond the diagnosis, beyond what's written on paper in the medical record. I think it's almost like malpractice to, behave as, that's not my problem. I mean, we don't have to be everyone's therapist. We there, there's boundaries of course. But to a certain point, if we are shutting out the wholeness of what it means to be a doctor, which includes like care, care, like really caring, actually caring and having time to care, having emotional bandwidth to care, having a structure set up so that you can care and not injure yourself emotionally and so that you can care and continue to care. I, I think that, that our systems are currently not set up to allow that. So the fact that people are burning out, they're compassion fatigue, they are morally injured, they are committing suicide. How, how is this surprising in this kind of system? You know what I mean?

Maryal Concepcion: 50:24

Absolutely. And I'm just wondering in terms of. Advocacy for humans who are listening, who have non-human humans like this is, this is the very anthropomorph, anthropomorphizing part of me who went to, like, I got my BS in anthropology. But it's like, just for the listeners out there who also want to help their own pets and animals be better cared for I would just love if you had any, take on how we can also help our own loved ones who might have fur or not fur. And they actually have hair and they don't shed amazing. Or their snake, you get better care or their snake. Yes. Very, very true. I worked at the zoo for eight years, so yes, these are all check, check, check things. But you know, like, do you have any, any words for the humans out there who could help better advocate for their animals?

Eve Harrison, DVM: 51:22

Yeah. Yeah, I, I absolutely do. I would say integrative care is something to consider. Usually the culture of integrative veterinarians is more inclined to be aligned with what I've been saying, like seeing the whole system, the person, the animal, taking a little bit more time. Integrative medicine as a rule tends to honor that principle. More holistic medicine as well. I would also say that if you are frustrated with your current vet, you don't like what they're doing, they're making you feel bad, don't go on Yelp and don't give them a pr a hard time. Just find a different bet. Who works for you, who makes you feel heard, seen, honored makes you feel like a, a valuable co-creator of the care you're a doctor, right? So you're of course gonna have opinions. You're of course gonna have research things. There may be things that the veterinarian knows that you do not. We find that sometimes with, with human doctors and nurses come in and challenge us, and it's like, well, that's not true of a cat. So I would also say a little bit of humility. We're doctors too. And I would say it's your responsibility to find a veterinarian that works for you, that you feel is caring for your animal in the way that you consider to be appropriate. And instead of sticking with a vet that you're frustrated with and, and creating ongoing friction or not seeing the care you want, move shift. Take the responsibility to seek out a vet that you resonate with.'cause they're, we're here, we're here, we're waiting for you to come our way. And we, we love to work with people who are in the know about human stuff. Whenever I have a, a human doctor or nurse or anyone, we talk shop all the time, it's like so fun to be like, oh my God. Like how would you treat this in an, an in a human? But yeah, I mean, animals are humans too. And, and when you can find a, a vet that feels that way and you can feel that they've done what needed to be done to create a structure that can hold a really healthy vet client patient relationship, that's, that's your vet.

Maryal Concepcion: 53:32

I love it. Well, thank you so much Dr. Harrison for joining us today. I hope that the audience, just got a healthy dose of reality check there when it comes to the corporate practice of medicine, and I'm so grateful for everything that you do, and I am so excited that we're both out there just spreading the word about autonomous practice.

Eve Harrison, DVM: 53:51

I love it. I'm so glad to be in touch with you. We're like the, the, the equivalent alternate universe realities of each other doing what we do. And it's just such a joy to, to know that you exist and to be on your podcast and that you've been on my podcast, et cetera, et cetera. And so cheers to many more collaborations, I hope.

Maryal Concepcion: 54:12

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.