An Update On Our Veterinary Practice Renovations

Welcome to another episode of Questions With Crocker! This week Dr. Crocker and Shane give an update on their practice renovations; the obstacles they've faced, plans for the future, what they would've done differently, and more.

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TIMESTAMPS
Intro 00:00
Dr. Crocker's Overnight ER Case 02:24
Dr. Crocker's General Practice Renovations So Far 09:28
The Next Steps For Renovating 20:23
Outro 24:48

Transcript

0:00

[MUSIC] Welcome back to another episode of "Quarker" with your host, Dr. Crocker, and my co-host, my husband, Shane.>> Well, I'm on the host.>> Well, probably because I speak at least 80% of the time, and you chime in.>> Yes.>> Do you want to be the host? You can take charge. You want to take over?>> I just want the title.>> I said co-host, so technically, you are the one of the host. I am Dr. Crocker. I'm an emergency veterinarian and also a practice owner in Texas. I speak and do a little bit of social media as a veterinarian. You are?>> Me. I am not a veterinarian.>> No. >> Or an Oman personality. What do you do? What is your contribution to this podcast? You want to be the host? What are your qualifications, sir?>> I'm just here to drink water, using my dot-mountain dues, but I'm out.>> Answer whatever question you ask of me.>> The podcast, you do bring a note of honesty and truth and a little bit of levity to the podcast. The podcast is based off of your questions. People ask those questions about being a veterinary medicine, about owning a practice, and we answer them and that is it. We need your questions to continue the podcast. You can follow us at questions with Crocker on any of our social media channels. You also can watch us on YouTube and we love feedback. People want to leave reviews. I got a great message the other day.>> You like positive feedback.>> I mean, all feedback is good. As I've not an older, I've realized all feedback is good, but I learned to go tip the other day as a leader. If you are giving feedback, you should actually ask someone, "Are you ready for feedback?" Not just throw up on them, basically. I felt like that was good because especially working in an emergency room situation, I work with young veterinarians, and sometimes you see them do something and you automatically want to say, "Hey, you should consider this or you should do this and taking a minute to say, "Hey, are you open to feedback right now?" It's actually great because it might be in a weird head space and it might not come across the right way. I'm trying to implement that in my life. I think it might be great for you also, the children, just making sure you're in a good head space before.>> There's probably a lot of value to it.>> I give you feedback, but I felt like that was something good to learn in my 40 plus years to actually ask people if they want feedback before we give it. That is our tip and trick of the day. We are here to talk about all things in veterinary medicine and I'm coming off a night shift and I look a little tired if you're watching us on YouTube. It was about a 13 hour overnight shift in the ER and I did have a doctor with me until about 2 a.m. We actually had a cool case, so it was only a four-month-old dog come in because the dog could eat in a squeaker toy. The squeaker toy was, I don't know, this big. What would you say?>> I don't think they can get that size on the podcast.>> I was about to describe it. I was going to ask you what you would.>> A baseball. It was a little smaller than a baseball, but it was also flatter, but it was plasticky and compressible, so the owner brought the other partner's squeaker toy to it. Number one, how the heck did a dog swallow that? That's huge, right? Number two, of course, it's a crazy active puppy. Because it's in the stomach and we had an x-ray that showed the beautiful outline of the squeaker toy in the stomach, we decided to try to scope it. Put it under anesthesia, put the camera down into the stomach and then grab it. Which sounds really easy. We were very hopeful because we actually had the other squeaker toy, so we tried a couple of the tools on it that we used to get stuff out of the stomach and we found some that seemed like they would work really well to grab it. Dog one under anesthesia, put the scope down there, found it, boom, right away, bright blue, easy to find, not a lot of food in there. Really your ideal scenario. Guess how long it took us to scope that out?>> I don't know what a normal length time is, let's say 10 minutes.>> A hour and a half.>> Oh my gosh.>> Yeah. So I told the owner from the beginning because I've done this long enough that I want to set like appropriate expectations. But any time you have something that is more-->> You were told me hour and a half of the, we'll see what happens.>> Well, the only other option is to do surgery and go in there and like open the stomach up which they want to avoid, obviously, this young dog. So I told them, "Any time you have something round and this is really common to the tennis balls because of round and there's no surface to grab." So you try to grab it, we actually have this wire thing that we push out and it's a loop and you try to loop it. But it's slippery because of the fluid in the stomach and it's round. So we literally get it like perfectly positioned and I'd be like, "So steady and they'd be pulling back tightening the loop and it would just slip off at the last minute.">> You think there'd be some grip on the other side of the wire piece?>> It is, it's textured but it doesn't matter because you just have to have it perfectly placed.>> The torus with tennis balls too because we also have like a little clamp that can grab stuff and we tried to put the clamp down there and like press against it and grab it because it seemed really soft at the other one we had but the clamp is just not strong enough to like really grab it because it has to be an instrument small enough to fit all the way through the scope but then also like open up and do what they need to do in there. So I set the expectation for the owner that scopes can last a while but we weren't going to give up. And honestly, I was about to give up. Like we've been doing it an hour and a half, you only have so much anesthesia time so I was actually talking to them about we might need to go to surgery just get it out and I had gone to make a surgery estimate and me and one of the other doctors Dr. Lake had been kind of switching off because there was other patients in the hospital and so we were switching off like as we needed to to try to get it out and then also see the other patients in the hospital. So I was going to make the estimate and I heard everyone go, "Ugh!" and so I ran over there and it was fun because we're open concept ER so the owners are there. They're videoing everyone standing around because scopes are just like cool to watch and they had gotten a hold of it and so everyone's like slow, slow and they're pulling it out slowly. I like one of those machines at the arcade. It's so that and so they got it actually out and then it popped loose right in the esophagus and everyone's like, "Ugh!" And so it's sitting there but it had compressed down so there was finally a sharp edge. We actually switched tools real quick, grabbed with the pliers, pulled it out and you pulled it out and everyone's like, "Yeah!" I mean it was awesome and so very rewarding. The dog did great. She woke up great. She honestly will probably eat something else again. I told them you probably should look into pet insurance because this will happen again. The guy was running, he said this, "Grigor Toy and Sam, this is the most expensive dog toy ever." Bye. But she went home an hour after the procedure because it's non-invasive and you get the pop mountain. So it was best case scenario for that but I have not and I didn't say the slas I had to munging myself but I have not had a successful scope where like I couldn't get it out and I don't know how long. Like I haven't had to take anything to certain. Love it, unsuccessful scope. Oh, you're right. I have not had an unsuccessful scope in, I don't know how long and it was going to be so mad if I could get this one out and so I was very thankful for Dr. Lake and her continuing to try while I was working on the other one and the team just like not giving up everyone. Kind of kept switching out and saying like let's try this tool. We were trying to rig like a bag that we could maybe put down in there and like scoop it out with because the other nets we had were too small. So it was definitely a team effort but it was really fun to do it successfully and the owner was so grateful. We didn't have to obviously do surgery on their dog. So it was a good case and even though I was tired and Dr. Lake was tired working them overnight, it was I don't know one of those moments that you're like this is why I work ER. It's very cool. And you know at some point that skill is going to come and come and handy with our dog. So very true. As of now I just make him throw up all the stuff he eats but at some point there will be something that will have to probably go in there and so it was an option for that dog. You could make him throw it up. So they had actually that's a good question. They'd actually tried that and the referring vet is a younger vet that I actually know and so she called me and said like we try to get this dog to vomit. She's mom it up food mom at this week or back up and so I was like send it over we'll scope it and so I thought about it and I said you know when do you get off and she said I'm about to be off and I'm like why don't you come over and like help me scope it. So she actually came over to the hospital and she helped run the camera and watched the scope the whole time and like was there the whole time the owner's like it's so cool that you know you came over to watch and so she hung out for a while. In the ER so it's just nice to like collaborate with people that work together and I think the owners felt very I don't know a valued and they really appreciated like all of us coming together as a team like not to give up on their dog. I think sometimes pet owners here know a lot more than they hear yes from emergency professionals in vet med just because of being sure stacked in other things and so I was definitely one of those like feel good this is why I do it cases so you like it. I do. I feel like you would enjoy something like that because it's like a video. I would for about 20 minutes hour and a half amount. You know how the patients the longest scope that I ever saw in the emergency room and it's because they it was like small pieces where they just kept pulling stuff out and pulling stuff out it was four hours and that dog avoided surgery but it was a long time. The worst ones are tennis balls don't let your dogs play with tennis balls. I'll just do pet owner PSA because tennis balls are perfectly round and there's no grip and then they have that fuzz on the outside. So if there's a tennis ball I don't even try to go in and scope in unless it's shooting a piece is where I can grab edges because you literally are trying to like grab and you just pulling fuzz off and pulling fuzz off. So I know now just take those dogs to surgery if it's an intact tennis ball because everything else we have won't fit around something that big but also like how does a dog swallow a whole tennis ball? That's what's amazing to me. I guess at least it's job security unfortunately. So that was our cool case last night. What did you do last night? So for the scoping companies they ought to think about a bigger net and a bigger yeah so the owner was actually asking that and talking about like they should do more contraptions and I explain to them that everything we have is actually like from the human world essentially because of the research that goes into it in patents and people don't eat things that big like people don't swallow things that are super big so everything they have probably is going to like be able to scope out something a person would eat. It's just dogs are worse. Just whist up. So he's like we should create something like if you do it I'll help you. I'll mark it the heck out of it but it's a lot of time and money to do that so but every time I scope I do think that like I wish we had a bigger basket I wish we had a better tool but I think it's just because it's not financially worth it yet for a company to do that. But hey next job idea for you? What? Next job idea for you. Oh, job idea. I thought you said one of me did do something right now. No, no, no, no, you're an entrepreneur though so you could invest in it. We could. You don't seem very motivated by that. That's it. No, it's a bit of a deal on that. So speaking of jobs we are going to do something a little different in this podcast and we're going to consolidate like a lot of questions I've gotten recently. We own a practice in Texas and we do. Do we have to scope it or practice? We do. We actually have two scopes because they used to do horses and you scope horses a lot of times like their airways and guttural pouches so we have two scopes. So if anybody needs a scope out to the animal hospital and for worth, we can help you out. But we are trying to update our practice. We are renovating. We have owned it for how long? Won't you give a little backstory? Probably a year and a half? No? I'm guessing. You're killing it with the co-hosting today. I mean the dead stuff. It's been a long, it's been a long day. Kill him here right now. A long day. I worked it overnight and I'm like bringing the energy. I need you to drink another round. I don't have any. That's the problem. Oh, we have. Nobody ordered Mountain Dews. Oh, we have a Mountain Dew deficiency. Shorted. Okay. That makes a lot more sense. So yes, we've owned it for a year and a half and one of the things from the beginning, like part of us buying it was knowing that almost half the building used to be large animal completely open and really was not being utilized. So knowing that we wanted to renovate that space. So we are in the middle of that. We put together a five year plan and that was in your like four. I'm pretty sure is the renovation. I can't help it that the practice has been so successful that we're outgrowing our current space. I'm just saying. So let's talk first about what are the reasons that we renovated? Do you want to give a reason first? We need to more exam rooms. We can't grow without having more exam rooms. We actually had this conversation on social media recently and I kind of asked about ratios and exam rooms and pretty much everyone agreed that an efficient practice is going to have at least a one to two like doctor exam room ratio. Right now we only have two exam rooms and we have two doctors. I also work there sometimes but two a day in a one to one doesn't work. I can only have one person seeing rooms at a time. So we're going to increase to four exam rooms and we're also going to increase our treatment space to dramatically our space to hold animals. And I'm really excited about building like a special dental area just for dentistry. That's also close to surgery. So we can also ask them out to exam rooms. Yes. So technically we have maybe six exam rooms. Yes, two outdoors. So part of this space is the old large animal that's enclosed and basically we're renovating all that to be our new small animal area with a new reception lobby exam rooms and then lab pharmacy. And then our old space is going to become X-ray, ultrasound, cat room, offices and our actual area for our team to have a space to like have one just relax. Right, exactly. Yes. So very excited about that. But it is a lot of work. So do you feel like it's going well so far? It is going. Yes. Do you feel it's going better than it probably could be going, it could be going loavers? What are some of the biggest challenges with all of it? I have the gate. We had to scale down our idea for probably two reasons. One, trying to get city to approve we wanted to do was going to take forever and cost a lot of money and to the cost to do we wanted to do which was ad square footage. Yes. I was just going to be cost prohibitive because we have a huge space. I don't even know how many square feet it is that's covered already off the back of the building. So 80 by 40 covered arena. So our idea was actually to expand all the way into that space almost and add like six exam rooms, have a much bigger lobby and just more space in general. But the cost to actually add on versus just renovating what we had the cost difference was I mean two, three times more. And yeah, and I don't when we looked at it, it wasn't going to make sense financially. And with the model. So I think with four exam rooms and having a special dental suite, having a surgery suite and having we're going to have three treatment tables plus a special procedures room. I really think I can still have like four bets in there that aren't all scheduled at the same time, but I can have three to four in there and that's kind of our goal. So I think that it was hard to change our expectation and anyone going into renovations should know that probably you'll have a plan A, but you're probably going to end up with a plan. Yeah, Z Z Z Z Z. We only redid our plans about 800 times. Yes. And honestly, as we were framing and doing things, we were changing it up as we went along. So that has been a little bit of a mental adjustment, but it's been really exciting to actually see it come about to walk through the framed area. And then we are getting a new X ray, which the entire team has pumped about. So we are outfitting a new X ray room. And that's the first room now to actually have new paint in it and new flooring and just seeing the clean, fresh base. I think it's visually helped the team like, no, why we're going through all this headache and what we're doing. Yeah, we have to be kind of strategic of how we do this because we have to continue to operate. So where the X ray is currently, we need to get in that area and work. So we need to set up the new X ray rooms. We can set up the new X ray, clear that space out and get in there and work at some point. So yeah, the where the X ray is is actually in surgery right now because it's a huge room. And we're going to move it into our it own area and then be able to enclose surgery to have a more kind of sterile space, which I really want, especially coming from an emergency setting, like what we have there versus what I have now. I really want to elevate overall like the medical quality that we're offering pets. So excited about that. I hated the fact that we had space that was unused. Yeah, we had a lot of dead space that was just not being utilized very well. I mean, I think the most efficient hospital is one where every single room is being used at some point in time. In general, like surgery needs to be full as much of the day as possible, dentistry needs to be full as much of the day as possible. I want people taking ultrasounds, doing X rays, I want, you know, the kennels full because you have drop offs. And so as much of our space being utilized as possible means better business and means more profits, which means we can do more for our clients and also take care of our team better. And so it was literally killing me the fact that half the building was just sitting there empty. So excited about that. And this is kind of phase one, right? So redoing the outdoor area or the indoor area. And then we're going to redo the old part of the hospital that we're currently working in. And then it's almost three phase. We've got to finish the new area so we can move into it. Yes. We've got to open it up to the existing treatment area, which is going to be probably the trickiest part because that's where we're going to be working around people who are actually trying to work. Yes. And then it goes off from that, but it's simply up over the walls and merge the two environments. Which let me just give a note to that. So we've tried along the way to really keep the team updated with like what we're doing, why we're doing it. There's a little bit that the new AC heating wasn't working and it was pretty chilly in there. Yeah, 50 degrees. Oh, it's that's pretty cool. The team's like, it's kind of cold. It's 50. I'm like, that's really cold. And then we also, there was like a lot of drywall type dust everywhere. Our family actually spent the weekend up there with the kids and we were like cleaning every surface we could because we're trying to do things on the weekend and then, you know, how people be able to be back in their Monday working. But I think our team has handled it really well. I know it hasn't been the easiest thing and unfortunately it's only going to get harder than just a little months. Yeah, just to get it pretty hectic. Yes. So as a practice owner, I think being transparent about like what the goal is, what the plan is and really explaining what's happening and why it's happening and prepping people for it is helpful. And I just try to be as like appreciative as possible with everyone for their patients and for putting up a stuff because we are literally moving and cramming stuff in places right now so we can get the renovation done and then move into the new space. But seeing the new flooring, the new paint, seeing things be updated, I think it's exciting for everyone. I would agree. So phase three, talk about that a little bit more. So that would be more of the renovation on the current side, which is paint, face lift, built to malls, new floors, that type of thing. That's phase two. Sorry. That's technically phase three. Yeah. What? No. So phase two is going to be us opening up and working in the middle section. So you have four phases and I have three. Yes. Okay. And then the fourth phase would be the outside work. Okay. So talk about the outside because that's one of the parts I'm most excited about. The outside is still unclear to me exactly what we're doing. Oh, the outside is so clear to me. The outside is one of the reasons that I actually was really excited about the property. I think the outside is unclear to you because of the price tag on the outside. Again, the outside is very unclear as to what the end result may or may not look like at this point. So to paint the picture, we have a huge covered area that had like metal pipe fencing that was really heavy duty. We had a big kind of open area that you could have I've stuck in and then smaller pens all around it. And so it's great because it's covered completely and it is attached to the hospital. So I was thinking like, what can I do with this space? We currently don't see livestock. We don't need all those pens. And so I had a great idea. Basically, we're going to create an outdoor area for our clients and also like an education area. So we cleared out like a majority of the pipe and we're leaving one section at the very end that if we ever do have like goat sheep horses that are run up there for something we have a spot to hold them. But a majority of it, I see the vision of being turfed on the inside and fenced. So that area is going to be narrowed down a little bit tighter with maybe some nice interpretive rock or something around it. It's worth it. You don't have to cut it. You don't have to take care of it. To the cost of it, we can hire somebody for 47 years to manicure it like a golf course. Okay, but let me let me finish. So be a nice putting green indoor area. I have a lot of putting. You can okay, how about this? You can have a putting green in the area. I will. That's already in the plans. Yes. Okay. So turfed in area more central and then we're going I want to have seating like actually not bench seating. What am I trying to say? You're bleachers. I want bleachers on one side and then I want outdoor exam. So everybody listening, if you always start putting together a budget on what you think is make cost, I would appreciate it. And then double it. No, but here's why. I want our practice to be very community facing. I agree. I think it's really important to be a part of the community. And I know that our local like 4-H and FFA needs spaces sometimes to do education, to do events. And I can see them using that space. I would love to have pet owner education courses. So talking about how to manage your dog in an emergency, what you should have in an emergency pack, what are signs of things that you need to watch for. Even basic like puppy care. I think that it could be a really cool space to utilize to really get the community engaged and involved with the practice. I also see us doing summer camps for like students like a vet camp over the summer. And I think that that would be great to just give back and encourage kids to think about being a veterinarian. We did like a small raffle and we had two kids come and it was really fun to have them do surgery and see the practice. And also it's good for business. It's good to be able to have events that you can market and you can partner with people. There's a couple of rescues that want to do like puppy yoga or want to do goat yoga and do like events. And we have this space for it. So utilizing that space to be able to interact and then also let clients, the weather is nice and they want to sit outside while they wait for their appointment or have an outdoor appointment, I think that would be wonderful. So it's important to me for the culture and like what I want the practice to be to have a space that can be utilized by people that are not just us. Completely agree. Why do you not look convinced? I feel like I was very convincing just now. Extremely convincing, but it all comes back to budgetary restraints. So this is where you and I like our philosophies differ a little bit because I think like what is it if you build that they will come? Right? Like I think that the revenue comes when you push the envelope and you do something different and you set yourself apart. Like there's no one in our area that has a space like that that does like a lot of interactive events and I think it sets our practice apart from everyone else. And it's just great for marketing. It's great for the culture. It's great for the team. You think that it's just expensive. I think build it and they will come is a great way to look at it, but you have to have dollars to build it. So you're saying I need to work more? Just saying we'll get to we'll get to face seven and we'll have more details. I'm just I'm noting now we're going to pull this podcast up at a year and we're going to have this space finished out and it's going to look awesome. You always get what you want just give me some time and we'll get it finished. I don't say I wouldn't say a whole ways, but there's some give I definitely think we've had to compromise on this project in general together. And I really love what we've come up with so far. Very nice. And I think the team is actually really enjoying it. So really the next phase is to continue to finish off. We're going to do the outside of the round of building to paint and finish the bottom of it. We're building. We're making completely new entrants and then what are some of the other ideas? We're adding a lot of windows to the building in general. Windows paint rock around the bottom. Yes. Just make a more appealing and then do the driveway parking. Yes. So explain a little bit what we're doing with the outside right now of what is a feasibility study. That is I think your mom just walked in. That's okay. The feasibility study is going to allow us because we have about a current land. We're going to try to figure out how can we better utilize that land as well? Because again, it's like we had open space that would have been utilized. We have land that's not being utilized. But we have to understand what will the city allow us to do. So what is the best bank for the buck? Is it build more buildings? Is it bringing food trucks? What does that look like? I mean because we have what over a naker? Right in a naker. Yeah. So we can do that. And that will determine how the parking goes and everything else. And again, for me phase 10 is actually potentially adding more space, commercial space to the location. I really for some reason had this dream a couple years ago of like a space where we built something that was commercial space for pet related businesses. And so that our whole area would just be like a pet center essentially. Yeah, a pet complex. Right. And we could be landlord to those areas. So we would have entities in there that were more pet related. So looking at is that even possible with the space will the city let us do that and what's the parking and then making a plan based on that. And for some reason, I think before we got into like renovating and building, I kind of thought like you just come up with a plan and do it. There is so much given take with like what is actually allowed on the property and what the cost is even for like doing the things you want to do. We have telephone poles that run right down the middle of our property and we want those gone. And so working with the city to run the electrical under instead of up on top. Yeah, the technically the power company. But yes, the power company. It's a lot of stuff that you don't think about. And so a lot of people normally have a general contractor maybe that's doing all that. Yeah, we'll need all that. But we got a shankocker. We don't know that. Or good to go. But I do think anyone who's looking to buy a practice renovate really needs to think about what goes into it and probably extend your timeline dramatically just based on kids to get started. The hoops you're going to have to jump through and the things you're going to have to do to get permits and get approval. The money part of it, I know that's a big part. I would say that's almost less of a big part compared to like the planning and all the other permitting and all the other things that can really set you back long term. I know people that have bought practices and it's two years, three years in and they still can't get the city to get on board with what they want to do and it can really push things back. Yeah, I mean, it was significantly different approval process to just renovate inside of our four walls. Yes. And it was to even, you know, even if we were doing the 20 foot out of them. Yeah, would be ridiculous. Yeah, so learning those things along the way. We want to share them so that hopefully somebody else kind of thinks about it a little bit more before they kind of get far in the process or buys a building or buys a practice thinking like, oh, I'll just do all these things and update it. It's not quite that simple. And I think we've done enough renovations that we already kind of knew it was not going to be simple. We had all these different plans. So we could change it based on what we wanted. But if I had gone into this saying like, we have to add on, I have to have this, we have to do this. It honestly would have been a failure. And we probably would have had a lot of fights, possibly potentially. I think we've been doing good so far. So, you know, marriage check in. We're still married. It's good. It's good. It's been pretty smooth. I think so too. It's been fun because we actually are showing the updates on our social media. We are. Yes. I created a renovation channel on my social media at doctor dot tenasia dot crocker. So people can see videos and actually asking people about ideas for seating in the lobby, color choices, kind of showing them the flow, showing them what's happening in our area and why we're renovating. So it's been fun to do like a behind the scenes. That's a good point real quick on that. I mean, part of the renovation process too was so that we could implement new customer experience and workflow in that process. Yes. That was kind of dictative of how we'd laid everything out and where we put doors and everything else as well. Yeah, because right now our practice, there was a lot of add-ons and it's a lot of like little rooms, no windows and you can't really communicate as a team very efficiently. You don't know like when people are in the lobby waiting, when they're in a room. And so we've been making it work, but ideally having something that's more open where we can communicate easier and the flow is better for pet owners and also our team was a huge goal. And probably our next podcast is going to hit a little bit on like workflow, efficiency and what we're thinking we want to do. And I'd love to hear people's feedback on like how they run their practices and their appointments because we're really looking at it. I think when you move in a new space is an opportunity kind of change it and make it what you want it to be. So overall, it's going well. It's exciting. On social media, you can follow us at AVAH vet or you can follow me at doctor to nasia.crocker to see the updates. And then if you want us to ask a question for the podcast, it's at questions with Crocker. You can watch us on YouTube. You can listen to us on Spotify or Apple. And please, please, please, please leave a review. I'm just going to laugh from the renovation. You should. Do you want to do with the access for the, no, that's actually a great idea. I want you to start going live for the renovation. You won't do that. I don't know how to do that. I'll teach you. I'll teach you. I'll talk about how James lives are going on there. So, thanks you guys so much for listening. If you have any other questions, please reach out to us. Or if you have feedback about anything, we would love to hear it. Have a wonderful day and I'm headed back to the yard tonight.[MUSIC]