Reimagining a Veterinary Consolidation Model (story of Dr. Bill Wagner)

If you are close to the veterinary industry at all, you are aware of the transition of veterinary business models to veterinary consolidation. What’s going on with veterinary consolidators, and are they all the same? What about independent practices is special and needs to be preserved? What could be improved? 

To answer these questions, Vet Life Reimagined invites, Dr. Bill Wagner. Bill graduated from Tufts Veterinary School in 2016 and already early in his veterinary career has experienced quite a few different paths in veterinary medicine. He started a veterinary company called Doc Wags that makes custom pet harnesses to hold medical needs. He also is the co-founder of Associated Veterinary Partners (AVP), a very different veterinary practice consolidation model. 

In this episode,

• What makes you unique as a veterinarian? Why would someone request YOU specifically to be their veterinarian? 
• How some entrepreneurial endeavors do not go well and what to avoid.
• How Associated Veterinary Partners is taking a different approach to vet practice consolidation. 

Resources

• Associated Veterinary Partners info video & website
• Tufts at Tech program
• Doc Wags
• Episode on YouTube (please subscribe!)
• Gift guide for veterinary people

Transcript

Megan Sprinkle: [00:00:00] The past five years or so has been pretty crazy with veterinary consolidation. What's going on with them and are they all the same? What about independent practices is special and needs to be preserved? And what could be improved? Welcome to Vet Life Reimagined. I'm Megan Sprinkle and our guest today is another VMX Connection and he's going to answer all of these questions.

Megan Sprinkle: Dr. Bill Wagner graduated from Tufts Veterinary School in 2016 and already early in his career, Has experienced quite a few different experiences. We talk about finding what makes you unique as a veterinarian, like why someone would request you specifically to be their veterinarian. Bill shares his first entrepreneurial endeavor that did not go well.

Megan Sprinkle: And then how he co founded associated veterinary partners, a very different vet practice consolidation model. Bill has tons of insights and a very unique perspective. So let's get to the conversation with Dr. Bill Wagner. When did you know you wanted to get into veterinary medicine? 

Bill Wagner: Yeah, and thank you for having me.

I'm a bit [00:01:00] of a non traditional path for a veterinarian in a lot of ways. One of which is when my decision happened to become a vet of, I was later on in life when that kind of came across my plate as something that I took seriously as a potential career. I always knew I had an affinity for animals.

Bill Wagner: There's a picture of me, I think when I'm like five years old, that At Christmas at our, uh, cousin's house where everybody's off opening presents and having conversation and I'm over there just lounging on the big black lab that my cousins had. All I wanted to do is play with the dogs while I was there and be antisocial and the animals were all the focus for me, but I didn't.

Bill Wagner: Really consider working with animals for a career was even a possibility. Through my younger years, I was interested in math and science. So, I decided being a precocious young child at a very young age, I was going to be a nuclear physicist when I grew up. I think I picked that out of, Oh, that's if I do, that means that I'm smart.

Bill Wagner: So I'll be a physicist. And then I had a [00:02:00] brief period where I watched Top Gun and then wanted to be a military aviator for a while and then realized that my vision was not going to agree with that. And then circle back around to physics. But my journey to decide to become a vet really started in my senior year of high school.

Bill Wagner: My high school had a program called Senior Project where basically the last month or two of senior year, they knew that students who are already accepted to college probably were not going to actually be paying attention in any of their classes. So, they sent us all out to do community service instead.

Bill Wagner: I ended up picking an animal shelter because it just made sense of I love working with animals and it would be cool to spend some time in an animal shelter. So, through that started to see the veterinarian at that shelter doing her work. And it just suddenly clicked for me like, hey, this is awesome. This is the merging of all the things that make me tick of you get to work with animals all the time.

Bill Wagner: But also it is, it's science, it's math, it's intellectually challenging, all these things that I wanted out of a [00:03:00] career when I grew up. So, I went into undergrad declared as pre vet, although I was still toying with the physics path. So, I did my major in physics, but ended up coming out of school and was also really into music at the time I play bass guitar.

Bill Wagner: So, I was in a band and we were playing a lot of shows around Boston in the Northeast and so forth. So, I took three years off in between undergrad and vet school to just kind of. Live life a little bit, play a lot of music. I was working as a vet tech as well, just making sure that I wanted to be on the right path.

Bill Wagner: But long story short, it was maybe a more convoluted journey. The average vet where most of my classmates in school, the answer to that question was by the time I was four years old, I knew that I wanted to be a veterinarian. Yeah. So, not the case for me, uh, knew I loved animals, but didn't really see it as a, a true career path for myself until really that kind of 18, 19 years old and didn't really fully a hundred percent commit to it until a few years out of undergrad.

Megan Sprinkle: I'm curious though, do you [00:04:00] still do music? 

Bill Wagner: Yeah. So, I've got behind me a bunch of bass guitars. I really felt like I was spoiled in that period coming out of undergrad where I had options where depending on which direction I leaned into, the other could still be a part of my life of if I decided to become a professional musician, which I was toying with at the time, that I could always have animals in my life.

Megan Sprinkle: It wasn't something that I was giving something up by not pursuing that met. If I went that direction. And vice versa, that if I decided to become a veterinarian, that music could always still be a part of my life, but would be a hobby rather than a profession. And I ended up deciding that that was how I liked music more anyways, that trying to make it into a living, took a lot of the things out of it that I enjoyed just being able to do what I want with it, unless you become a rock star, which I realized pretty early on in that journey was not going to be realistic for me, that if you really want to make a career in music, it's a lot Teaching and cover bands and things like that, wedding bands, [00:05:00] maybe not something I was as passionate about.

Megan Sprinkle: So you went to Tufts, which is a fantastic school, they have a really good nutrition department. So how was your vet school journey? You might be maybe a couple years older than some of the other students, but of course there's all ages that are in our veterinary classes, but what was your experience going through vet school?

Bill Wagner: Yeah, it was down and then up my first two years of vet school. I had a rougher time with, it was definitely an adjustment. I think also after three years of being in the workforce and doing what I wanted. It was very unstructured as well. Like at any given point, I would have basically like three jobs, usually one of them full time and two part time.

Bill Wagner: So, I was floating around a lot. And then suddenly going into this hyper structured environment was a bit of a cold plunge. And so, I passed my classes. Thank goodness, certainly there were a few that I think I got a little generosity from my [00:06:00] professors, along the way to, to get me somewhat through, especially some of the first year classes, but it was a little tough as well.

Bill Wagner: I was. I just really enjoyed the clinical side so much and the hard science is suddenly, ironically, the thing that kind of got me interested in vet med in a lot of ways, I became a lot less passionate about. And once I'd been out and working in vet med, I just wanted to get to what I thought was the good stuff, which was the really, truly clinically relevant stuff.

Bill Wagner: It's honestly, it's all clinically relevant, but maybe less directly. Like most people, we do better at the things that we're passionate about and interested in. Once I got to third year, I think I really hit my stride that it did become heavily more clinically focused. I think I found a good routine and self-discipline and focus to it where I understood what I needed to do and how to manage my time to be successful.

Bill Wagner: Fourth year, I just had a blast, and you get out into clinics and I didn't enjoy all of them. [00:07:00] The hours, and this is something that's one of my many kind of pet projects, is I think that academia has a lot to learn in terms of how to set up fourth year students for success. When you're getting into your 90th hour of the week that you're working, your brain

Bill Wagner: is mashed potatoes. By that point, you're not absorbing any more knowledge. So, it's no longer a productive exercise for you to still be in the building, but I think some of kind of the more extreme rotations in terms of just physical exhaustion, I really enjoyed that stretch. And in particular, Tufts has one of their

Bill Wagner: core rotations, but it's also something I spent a lot of time on electives with called Thompson attack, which is basically a community health rotation where the school has a relationship with Worcester Technical High School, which is based out of one of the not as nice areas of Worcester and they end up bringing in a lot of students for a vet assistant certificate program.

Bill Wagner: So, the high school students go through a certificate program [00:08:00] to become a certified veterinary assistant. So, it's not a technician program, but they still come out with a very high level of proficiency and being able to jump right into a veterinary hospital as their first job. And out of the school, they run a community health clinic where folks are able to bring in their pets who qualify as being low income.

Bill Wagner: So, there's criteria in order for people to be able to bring their pets there. But. Essentially, it functions as a clinic where the fourth year vet students from Tufts are the clinicians and the high school students in the veterinary assistant program act as the assistants or the technicians to, uh, those clinicians and it's supervised by licensed veterinarians who are double checking everything to make sure everything's done well.

Bill Wagner: But it was just a really cool opportunity. I was able to cut my first pyometra there. I was able to do really extensive dental work of, you know, extracting 10 teeth off a patient, stuff like that. Cases that in the teaching hospital, they don't let you out of the corner of the room to even see what's going on [00:09:00] behind the drape kind of stuff.

Bill Wagner: It's a really awesome rotation. Highly recommend anybody who's looking at Tufts or is in Tufts right now, spend as much time with Dr. Wolfenson and his team there. It's also your first time of really being the clinician in the room of delivering bad news. I did my first euthanasia there where I was having hard conversations with somebody whose pet was in an end of life situation.

Bill Wagner: So that was in fourth year. I spent as much time as I could there because that was really what got me out of bed in the morning was, Hey, I really want to be a practicing veterinarian, which ties into the, what the heck am I doing here as a practicing clinician at the moment that was in that school where I really felt I found my stride was in, in the second half of it.

Megan Sprinkle: Yeah. Yeah. One, it sets you up for understanding the real world after vet school. That would have given me so much more confidence and, oh, you're going to have to use communication skills and sometimes those are some of the hardest things to learn. You got to start just doing it to start to learn. And I [00:10:00] love that you are also able to work with veterinary assistants because I have this idea and there are some places that are doing this, but the vet student training is along with either vet techs or vet assistants.

Megan Sprinkle: And it allows you to understand the roles in the hospital and how you work as a team. And I, I think, getting those skills and understandings earlier during our training could be really helpful going into practice. I don't know, any thoughts on that? 

Bill Wagner: Yeah. And that's on my long list of things that I'm passionate about is how the profession is thinking about just the various roles within the profession. ‘Cause I know it's a hot topic issue of do we add mid level practitioners and things like that, and I tend to be in the camp of probably disagreeing with many of the other corporate peers in terms of, I think that. We need to be focusing instead on how do we have veterinary technicians practicing to the top of their credentials as true [00:11:00] nurses.

Bill Wagner: I don't often point towards human health care as being something to inspire towards. I think that the human health care system, at least in the U S has a lot of issues with it that need to be addressed. But one thing that I do think that they do very well is that they understand that nurses are not only important parts of the care delivery, but they're, if anything, a central part of the delivery of care, that doctors can't be in all places at all times.

Bill Wagner: And frankly, their skill set is often not up to par. Best used to the folks who end up going through that level of education. Maybe you're not the best communicators or maybe not the people who have the ideal EQ to be having tough conversations and things like that. And this is where nursing staff can really shine in a lot of ways and something that.

Bill Wagner: I think the veterinary profession is behind in a lot of ways, not exclusively. I think there are a lot of practices out there that do a phenomenal job of utilizing particularly their credential technicians to be at the centerpiece of how they deliver care, but also having clear [00:12:00] expectations and professional development and things like that for veterinary assistants, for client service representatives, for all folks within the profession to see how being a part of veterinary medicine can be

Bill Wagner: exciting and intellectually stimulating and also has opportunity for advancement in their careers. Because yeah, I think that not everybody has to aspire to do something different than what they do already. I I'm a big believer of if you find your home and in a profession, there's nothing wrong with being at home, but certainly for folks who are looking to advance their careers, I think it's really a good thing for the profession to provide paths for that.

Megan Sprinkle: Well, so we talked about that this hopefully allowed you to be prepared to go into the next step, but how was your transition into becoming official veterinarian in general practice? 

Bill Wagner: Yep. And that was one area where I did feel the years that I spent working, you know, in veterinary practices in [00:13:00] those in between years did help a lot. I felt that maybe my transition was a little smoother than the average. I understood the dynamics of. what everybody in the hospital does, what's my role as a clinician, just watching a lot of veterinarians work and how they communicated. I have been absolutely spoiled in the quality of the mentorship that I've gotten over the years, uh, both before vet school and after vet school of having a lot of really awesome clinicians who are great communicators who I was able to watch and listen and see how they operated, how they handled difficult conversations, how they.

Bill Wagner: Handle difficult situations. ‘Cause that's one of the big parts of practices is that everything looks great in the textbook. When you get out there and you start doing it, everything is messy. It's fuzzy around the edges. Things don't fit easily into boxes in the way that you're taught in school that they're going to.

Bill Wagner: So that was something where the quality of mentorship that I had in my life did me a lot of favors and I'm just eternally grateful to everybody who dedicated their [00:14:00] time and energy into being teachers and mentors to me. Bye. The first couple of years, I also landed at a relatively large general practice.

Bill Wagner: So, I was doing a small animal general practice out of school. I was on a very traditional path. I figured I'd worked for five to 10 years as an associate and then eventually go into practice ownership as obviously I'm. Doing very different things than we originally set out to do. But the first couple of years being at a larger practice, I think was an advantage as well.

Bill Wagner: I did have a lot of people that I could lean on, a lot of clinicians that I could go to, a lot of technicians and other non veterinarian leaders at those practices as well, who just could be sounding boards to help me in those formative years. I think the first year out of practice, I see as learning how to walk.

Bill Wagner: It's the fifth year of vet school. There's just so much that you're taught in those four years. And in theory, you've got the base of knowledge that you need to be an effective clinician. In practice, there's [00:15:00] still a lot of holes there. It's impossible to retain everything that you learned in school. And even if you did retain everything that you learned in school.

Bill Wagner: Medicine's always evolving, but also you need to get a sense of how the textbook differs from reality and developing an intuition. Maybe this is not the best thing to say outwardly, but I refer to it as the don't kill anything stage. You're coming in every day, just paranoid that you're going to make a mistake, that you're going to do something wrong.

Bill Wagner: And one of your patients is going to be worse for it. And that's a good paranoia to retain throughout your clinical practice. I think it's a bad thing if you ever lose that paranoia entirely. It should become a more comfortable voice where it's not screaming in your ear and you've got a good relationship with it, but you should always be worried about not making mistakes.

Bill Wagner: Certainly, the first year is just defined by that voice actually being the megaphone in your ear, making sure that you don't make any really big screw ups and knock on wood. I was forced to have any major screw ups. Certainly, we all make mistakes, but you [00:16:00] try and mitigate the scale of the mistakes. But.

Bill Wagner: The second year, then I think is really the figuring out who you are as a clinician, because why does somebody bring their pet to Dr. Wagner specifically versus some other veterinarian? Because at the end of the day, the core competencies of the profession, in my extremely biased opinion, veterinarians are as a whole.

Bill Wagner: an extremely skilled, intelligent, capable group of people, you're not going to be doing a disservice to your pet to bring them to a credentialed veterinarian. So then at that point it comes down to what specifically about that clinician sets them apart. Why would a client keep coming back to them? And that is going to be a different answer for every clinician.

Bill Wagner: Everybody is going to find their own approach, their own philosophy, their own communication style. I think you can't really develop that in your first year. Cause again, you can't run before you walk kind of situation. You can't develop your personality as a clinician until you get through that. [00:17:00] Core competency building stage.

Bill Wagner: And that second year is when you really start to have your shields, uh, of how you approach certain cases, how you like to communicate with clients, how you read a room, how you handle different situations differently, even if you're maybe dealing with the same medical situation, just based on a family situation or whatever it is that.

Bill Wagner: You develop the nuance to your care and you're not going to leave your second year with that identity. I think you probably don't leave your fifth year with that identity fully crystallized, but certainly I think that's where you start that journey of figuring out who do I want to be as a veterinarian.

Megan Sprinkle: I love how you describe this. And I was actually about to ask you, how do you start to clarify why people are coming to me? Do you implement client surveys? I think that's a really helpful question because This was something that I worked on when I was a resident and then looking for the job after the residency was I went around to all the people that I worked with very closely [00:18:00] within the vet hospital and I just directly asked them, I said, Hey, what did you like about working with me and it helped me get the words so I can advocate for myself looking for that job next.  Do you have ways of trying to decide or clarify those questions?

Bill Wagner: Yeah, it wasn't quite a journaling exercise, but I kept notes of what I think, particularly when I encountered a difficult case or a difficult client situation and put my thoughts into writing for myself. So that way I could go back later and say if I found myself in a difficult situation, but I've also just found writing is a thought exercise for me.

Bill Wagner: That's part of why I've got my blog on our website. 50 to a hundred blog articles at this point. And as much as it's an external exercise, it's a chance for kind of us to speak to the broader audience of the profession of how we as a company think about things. But it's also something that I do for selfish reasons of it just helps [00:19:00] me think through challenging topics.

Bill Wagner: Usually any blog post that's coming out usually has a story behind it. It's something that we. At the AVP level had a conversation about internally of how do we want to purchase? How do we want to think about this? And then I sit down and I just journal about it for, you know, a couple of hours and, and use that as a way, put my thoughts in front of me because.

Bill Wagner: Forces you to really reflect on something, to see words on paper, on a screen, because you can, in your own brain, you can build any narrative that you want, and you can reinforce any narrative that you want, when something is, is written down, it, it becomes a lot more concrete and, and harder to build gymnastics, to build logical fallacies and things like that.

Bill Wagner: Like circling back to your question of how do you develop that personality and how do you get external feedback around that? I think that for me, it was a bit more of an individual process of doing that writing process. But the other [00:20:00] thing was paying attention to. Who was it that stuck with me? ‘Cause especially we were a larger practice, lots of clinicians, we worked rotating schedules between multiple locations.

Bill Wagner: So, it was very easy for clients to move from one clinician to another without any hurt feelings or anything like that. They could either be a client who came in and saw any doctor or they could be a client who came in and requested a doctor specifically, and in order to do that, we'd have to call ahead and say, Hey, What days is the person working and what location are they going to be at?

Bill Wagner: So there was at this particular practice, a decent amount of work that a client would have to go through to work with a specific doctor. But it was very apparent to me of, hey, there's certain people who seem like they resonated with me. They want me to be their specific doctor for their pet. So, I started to try and look at, What are the common themes between these clients that maybe defines them in terms of their goals?

Bill Wagner: And one thing that I noticed was it was often [00:21:00] clients who really had a interest in education and as a back and forth education exercise. So, I've never been insulted by a client coming in with Dr. Google. It turns into a teaching exercise of explaining to them of, Hey, there are different resources out there.

Bill Wagner: Fair equality and stuff like that. And I will be able to speak from the resources that I consult that evidence based and so forth. But I noticed that they were the clients who really valued that extra five minutes or 10 minutes at the end of an appointment where we sat down. And we didn't just talk about the, what of what we were trying to do, what we were trying to accomplish with their pets care, but really getting into the why if we've got a, Patient renal failure really sitting there and talking through not to the depth that you would in a vet school lecture by talking about what is it that the kidneys do?

Bill Wagner: Why are we switching the diet? Why are we doing subcutaneous fluids? Stuff like that of these things that are going to require their buy in as a client in [00:22:00] order for them to be compliant. And some clients are not going to be compliant with things unless they get the why. And those tended to be the clients that Came to me, I got a bit of a reputation for having difficult clients that when they went to other clinicians, that they were maybe not as nice to them

Bill Wagner: as they were to me, I understood my niche, that these were people who if they didn't get their “why” they maybe were not patient about not getting their why, but that allowed them to resonate with me as an individual clinician. So, everybody's going to have their. On journey of trying to figure out what it is, but I think actively paying attention to who it is that sticks with you is an important part of developing your identity.

Bill Wagner: It's something that we, we talked about at the AVP corporate level as well. When we went through the exercise and setting core values for the company, if we've got five core values that we make all of our. Hiring and firing and partnership decisions around these values. And one of [00:23:00] the most important pieces of that we got from multiple resources was this idea that your values should be what you actually live, not what you aspire to.

Bill Wagner: They should be honest values because we can all say, Hey, I want to be like this, but that may not be honest and authentic to who you are. Your value should be something, not just that you aspire to live, but something that you, you already live every day. Accentuating that. So that's, I guess, part of the client journey is, is making sure that you are leaning into what your strengths are, what brings people back to you.

Megan Sprinkle: Thank you. And I don't think we talk a lot about that and understanding you as an individual and, and how you bring your special gifts into a practice setting or your work setting, it doesn't have to be in clinic either, but no, I think that's a really important topic. And you were very excited to be a practicing veterinarian, but you definitely have some entrepreneurial endeavors that came [00:24:00] into your work. And actually even early on, so 2017, you founded a pet care product company. So how did that come about? 

Bill Wagner: Yeah. And that was, um, I feel like a accidental multiple entrepreneur. That's that thought of, uh, I guess many entrepreneurs probably say that. I, I think, uh, there's some folks who get into entrepreneurship because they love the idea of entrepreneurship.

Bill Wagner: And then there's people that kind of fall into the cohort of myself, where it was more specific opportunities that I got excited about that entrepreneurship became a symptom of that rather than think the original goal. I was early on in practice and I've always had a. Engineering tinkering streak to myself.

Bill Wagner: There's a lot of things still around my parents house that have stripped screws on the back of them from me as an eight year old going around with the screwdriver and taking things apart to see how they work. Fortunately, I never electrocuted myself too badly, but that was always my mindset. I [00:25:00] wanted to understand how things work.

Bill Wagner: And that made medicine such a natural bit; medicine is all about understanding how the body works, it really is at a base level, it's a machine, it's a system to understand. So that kind of resonated with my particular way of thinking about things. But when I got out into practice, I started to see things, see gaps, see situations where clients were being approached with problems, where we would tell them what they need to do.

Bill Wagner: And they just didn't have the tools to do it, uh, or the tools just didn't exist. It's all well and good to say, Hey, keep the collar on a post surgical patient. But when you've got the six month old husky who just got neutered or a German shepherd or whatever high energy breed, that becomes a situation where you've put a instructions in the hands of your client.

Bill Wagner: That kind of everybody in the room knows is not realistic to follow through on short of breaking out the hydros dose trazodone don't facilitate that process. So, I started to come up [00:26:00] with random little inventions that might make clients lives easier. Uh, one of those was the idea of building a modular dog harness that you could attach various medical devices or lifestyle devices, stuff like that, including attaching an Elizabethan collar to the harness so that the crazy dog can't pop it off.

Bill Wagner: I had a few invention ideas. The, the harness was the one that I leaned into saying, hey, maybe I'll try and make this, I have no background in product design. So, this was the start of. How that first project didn't work out well, if you built a checklist of all of the early entrepreneur mistakes that you can make, I hit bingo, top to bottom.

Bill Wagner: Tried to do it by myself in an area that really was not my area of expertise. And also trying to do direct to consumer online merchant. That is just a very noisy space in the pet sector, tons and tons of competition. It becomes at the end of the day. As much a marketing enterprise than [00:27:00] anything. My wife works in marketing.

Bill Wagner: So, she'll be the first to tell you that I have no idea what I'm doing around marketing. So yeah, it was an awesome experience to just try and do something on my own. It never really got off the ground of, I did get a product design, minimum viable product, the MVP. Although that was another one of those kind of early entrepreneur mistakes of not validating the market fully before getting truly invested in terms of your time and energy.

Bill Wagner: So I carried this on longer than I should have. So I spent a few years of trying to make it work and it just really never found the traction that I had hoped for. When I set out on it, I haven't like truly given up on the idea that some point I might circle back around to this, but I could. Write a book on the number of lessons that I learned through that process of things that benefited me, both as a clinician, just in terms of how I think about approaching problems and asking for help and building the right teams and things like that, but particularly in terms of then [00:28:00] going out and building AVP together with my co founder, Dimitri, there were just So many pieces of, of wisdom and knowledge that I picked up through that knocking on all the wood here, but helped us be more successful in my second entrepreneurial adventure.

Megan Sprinkle: And you mentioned one of the reasons you started the Doc Wags, the product company was that you were noticing gaps. And based on our conversation at dinner at VMX, it sounds like that also was part of going into this other endeavor as well, was that you were starting to notice some things about certain consolidating clinic styles and business models that you felt had some gaps or it could be done a little bit better.  So what was that story of you seeing what was going on and then deciding to do something yourself? 

Bill Wagner: Yeah, it was another one of those accidental entrepreneurship situations. So about three years into my just shy five years that I was [00:29:00] working at, at that practice as an associate, the owner was approaching retirement age. So large practice, not realistic for any of the existing associates to be the buyer for that practice. So, it's one of those situations where there needed to be more of an institutional buyer. And that's what ended up happening was the, the group of practices sold to at the time, not particularly large, but it was since then become very large, relatively traditional corporate group in a lot of ways.

Bill Wagner: And I don't bear them any ill will. I think that they, like many corporate groups came in with good intentions of genuinely trying to make the clinics better. I just personally had some negative experiences along the way with that process, which again, I don't think was specific to that group, but more maybe in a sense of identifying that I, like many in the profession.

Bill Wagner: Was not born to march to the very traditional corporate drum that introducing a lot more structure into a business can be a good thing or a bad thing, depending on your perspective and depending on [00:30:00] the quality of the structure that's being added. But that certainly this was a wake up call for me about what was going on around the profession in terms of this trend of consolidation of corporatization.

Bill Wagner: Never worked at a corporate hospital before that. I'd always worked at independently owned practices through my technician days. And it was more of a large nonprofit. I worked at Angel up in Boston, which is the, the MSPCA's large emergency and specialty facility there. And so I'd had some exposure to a more bureaucratic arrangement, a very large organization, but.

Bill Wagner: In general, I was aware of the existence of veterinary corporate groups, but I really didn't know what that meant other than the fact that when I came out of school, I just knew I didn't want to work at a corporate hospital. So, I looked at independently owned practices when I was in my job search. So that was a moment of reflection for me, uh, going through that transition and figuring out what that meant for both me personally, in terms of my goals and what this meant for the profession in a broader sense, for me personally, in [00:31:00] terms of my goals, I started to get very anxious about what the idea of independent practice ownership was going to look like, of making essentially, A true light commitment, financial commitment of, whether it would be purchasing a practice or starting a practice from scratch and having.

Bill Wagner: Also at that point, I was in the middle of an entrepreneurial journey where competition became a very big factor in why it was not successful of just having so many large players in that particular space that I just didn't feel like I even had an opportunity to spread my wings, even if I felt like I was bringing maybe a good product or a good value statement to the market.

Bill Wagner: It's very hard to go up against giants when you're trying to operate a business. So that was something that was very in the front of my mind. Does this change my goals? Does this change my plans? Especially I live in Northeastern New Jersey, not far outside of New York City, very high corporate density of clinics.

Bill Wagner: And I wanted to stay in that part of the country, which I do, because my wife [00:32:00] and her career are anchored in New York city and we're just on our path to starting a family. So just a lot of factors that made me realize that the journey ahead was maybe going to be harder than I'd originally planned. And then on the flip side.

Bill Wagner: Made me worry about what this meant for the profession as a whole, of seeing myself as kind of somebody who maybe didn't fit within that mold of maybe what the corporate groups were going to be looking for in terms of maybe a good work grant or something like that. Especially when we talk about the very large corporations and their relationship with the folks on the front lines.

Bill Wagner: But if this becomes human healthcare, where it's extremely consolidated, heavy private equity and institutional investment influence and things like that, that That worried me if somebody who still wants to be involved in this profession 30 years from now, maybe not 40, we'll see how I'm feeling, but certainly I am not looking to stop being involved in this profession down the road and I just worried about what the landscape was going to look like if this [00:33:00] consolidation trend continued on the trajectory that it was on.

Bill Wagner: None. It seems like many things, the universe knew that I was in a moment of transition, trying to figure out what was next. And I got a call out of the blue from my forward college roommate. And he comes from a finance background. And he, he called me and said, hey, I've got this buddy, Dimitri, who also works in finance.

Bill Wagner: We know each other. We volunteer at the same nonprofit in the city. That's how we met each other. He's a really good guy. He is looking to talk to a veterinarian to run some ideas. And I initially was hesitant about the idea of hopping on a phone call with somebody who I'd never met. And why am I giving up my time to help somebody out?

Bill Wagner: But I decided it was going to be the right decision. And also. Not coincidentally, my college roommate, Justin had just agreed to be the officiant at my wedding. So, I figured this was probably a good time to be in the mentality of yes. So, I ended up taking the phone call with Dimitri and it was just like a match made in heaven.

Bill Wagner: We just very clearly saw the same [00:34:00] problems with consolidation in veterinary medicine. We came to it from different directions of he comes from an investment banking background. He spent about 10 years in private equity and investment banking in New York City. And in his most recent role before starting AVP together with me he was working at A large private equity firm that like many large private equity firms was super interested in the idea of investing in veterinary consolidators.

Bill Wagner: They had him leading due diligence on a few different veterinary consolidators that they were looking at as well. Perspective investments, and he started to look at these companies and it was also a accidental expert situation of he had in previous roles in investment banking, looked at several consolidation companies and in other industries, not in veterinary medicine specifically.

Bill Wagner: He had a good knowledge base on that particular business model, which part of how he ended up falling into looking at veterinary medicine when they were looking at consolidation investments. As he [00:35:00] started to look at these particular companies that they were thinking about investing in, he was surprised by what he was seeing and not with a positive connotation of the word surprised.

Bill Wagner: There were some on a relatively core structural issues that he was seeing with how they were approaching things. And there were a few big red flags that he saw. The first was that they were growing way too quickly in his eyes. Consolidation companies by definition should be growing. If they're not growing, it's a problem.

Bill Wagner: That means something's gone wrong because it is a mergers and acquisitions business at the end of the day. But like all things in medicine and otherwise, balance is very, very important. And he was seeing that this seemed to be out of balance, that they were just. Growing at astronomical rates. They were buying, buying, buying tons and tons of clinics.

Bill Wagner: And that kind of raised the rhetorical question in his mind of how do you do that? Well, how do you grow that quickly and not run into some major problems? Cause you've got to be building systems, building support, delivering on commitments. And every single one of these businesses [00:36:00] is different. They've got the same core business model.

Bill Wagner: They're all small animal general practice hospitals, but they all have their own cultures, they have their own approaches to care, they have their own clientele. These are not uniform businesses. So how do you welcome multiple a week for some of these companies that they were acquiring? This was just kind of mind boggling to him of how do you do that well?

Bill Wagner: And the answer was you don't do it well. You create a lot of problems when you try and grow too quickly and without Disciplining your approach and being thoughtful in terms of who does and doesn't fit with your network. Uh, cause every network is going to have its own flavor and its own approach. And if you're not being thoughtful in terms of who you build relationships with, you, you cause problems.

Bill Wagner: So that kind of led to the second big red flag that he saw, which was that these companies were just struggling massively with turnover of their clinical teams, that veterinarians were leaving, managers, technicians, assistants, CSRs, you name it, across the board, within 6 to 12 months, there were just waves of turnover, that people did not want to [00:37:00] work at these companies or at these practices as they went into new ownership with very distinctly different philosophies.

Bill Wagner: And that's not a positive or a negative value statement of whether or not those philosophies are good, just that they were very different, that there was a mismatch. So that was what he wanted to talk to me about was he wanted validation of, am I reading the room wrong? Are these companies better than I'm giving them credit for?

Bill Wagner: And just, I stumbled upon maybe their one pain point, that kind of situation. And I validated, no, I think that you're onto something. If I think that there is some very, concerning underlying consistent mistakes across many of the large veterinary consolidators that are being made. And then the second thing you wanted to talk about was, Hey, I've seen consolidation done thoughtfully in other industries, it's a business model that can be as good or as bad as it's executed on that there are ways that you can add value by creating a network that, uh, if you're thoughtful about who you work with.

Bill Wagner: How you work with those teams, with those clinics that [00:38:00] you can create value. And he was saying, I've seen it done well. What do you think is missing in vet med? Why are these companies not doing it? Is it something that's fundamental to the industry that makes this challenging? Or is it just that it's just not a priority for these groups to approach things in this way that maybe it's an issue with their thinking.

Bill Wagner: So, one conversation turned into a few dozen. This was in early 2020 that we got connected to each other and the world has gone through just a touch of a people around that time. So, it's an interesting time to be meeting a potential co-founder of a business. We ended up respectively deciding that we did see the world in a very similar way.

Bill Wagner: And we're both excited about the possibility of creating a new veterinary group with a different approach to things. So, we quit our jobs in late 2020. Like many entrepreneurial journeys, it was a big leap of faith. We were in it to win it. We ended up forming our first partnership with the clinic in October of 21.

Bill Wagner: So we spent just shy of a [00:39:00] year kind of building theory, crafting, figuring What we actually wanted to do differently as a company, cause it's all well and good to sit there and say, Hey, we think the other guys are not being as thoughtful as they should be. And we think that we can do better if it was that easy, everybody would do it kind of thing.

Bill Wagner: We wanted to make sure that we spent a lot of time actually delivering a better value statement because. The worst advice that we ever got along the way was from a prospective investor who we ended up not deciding to work with. In our early days, they just basically said, hey, you need to get in the game as quickly as you can.

Bill Wagner: If you're sitting on the sidelines, you're missing opportunity. Your first few acquisitions, partnerships may be challenging because you're not going to know what you don't know. But that's just the nature of building something. You're not cooking until you're in the kitchen kind of situation. We rejected that advice.

Bill Wagner: We didn't feel that that was the right way to approach things, that we wanted to really be thoughtful and make sure that our initial partners did have a [00:40:00] better experience. Certainly, our early partners knew that we were a new group and that there was going to be growing pains as, as we grew, but you know, that we wanted to be as thoughtful as we could when we, we got to the starting gate of things.

Bill Wagner: So it's been a wild journey. We're at 16 partner locations at the moment in 12 states. We work exclusively within a joint venture model or a partnership model, uh, co ownership. So we have local co-owners at every single one of our partner locations, which really is the thing that we decided was going to be what we did differently.

Bill Wagner: When we sat down and for those, you know, 10, 11 months before we started operating back clinics and saying, what can we do that's different? And. We really felt that leaning into this idea of partnership, we're not the only group that does partnerships, but we feel that our iteration of partnership is the most authentic to that word of really being relationship driven, local leadership, being empowered and being at the center of it all that we are here to support local leadership and not the other way around that [00:41:00] we feel is.

Bill Wagner: The missing element of aligning incentives and capturing that spirit of entrepreneurship and ownership at the local level. That really is what in my eyes makes independently on veterinary practices special, because if you ask any veterinary consolidator, like Are independently on veterinary practices, good businesses.

Bill Wagner: They should all hopefully tell you, yes, they are. There's a reason why they buy them. They're very passionately run small businesses that exist for a very clear purpose, have a very clear sense of what they do. So, these are great businesses. It's everybody. Wants to come in and say, oh well, we're going to make them better.

Bill Wagner: But I think a lot of the conversation needs to center around how do we preserve? How do we take what is so special and great about independently on veterinary practices and carry that forward? Because it's great to add on value incremental to that. But if you're not preserving the core value that you've invested in the first place, you’re not going to succeed.

Bill Wagner: And that's where I think a lot of the other veterinary groups have tripped up, [00:42:00] obviously coming from a very biased perspective, though there are competitors first, they, they may have a different perspective on things, but yeah, sorry. That was a long answer to a short question, but that's been the AVP journey in a nutshell.

Megan Sprinkle: You make a good comment about preserving what is special. And then I want to somehow pull that into something you said, as we were starting on. We are going through a transition in veterinary medicine. There's a lot that is changing, especially in the consolidation space, because my goodness, practices, like you said, we're getting bought up by the day, by the week, and then it slowed down because the economy did some crazy things.

Megan Sprinkle: And then now Chewy's getting into general practices and. So there's a lot going on and that's just one element of what's going on in vet med. I think there's a lot else too, but what's your perspective on this change in the profession? What do you think we should preserve and what are the things that you're actually excited about [00:43:00] in that growing direction?

Bill Wagner: Yeah. And this is where I will hopefully sound different than maybe any other person in my industry. Maybe there may, there's probably a few who share this perspective, but I always want to be the second best option in the eyes of our prospective partners. I think that independent ownership is the key.

Bill Wagner: Best version of veterinary medicine, at least on the value side in terms of what it is that makes veterinary medicine special as a profession. I think veterinarians being in the seats of ownership and leadership is just critical for the health of our profession and certainly independent ownership is the most extreme version of that.

Bill Wagner: The most committed version of that where truly the veterinarian is in not all veterinary practices independently owned or owned by veterinarians, but most of them are having a veterinarian in that true decision making seat where we just have that built in trust of knowing that this is a colleague [00:44:00] within the profession who went through a lot of school, a lot of life commitment to become a veterinarian.

Bill Wagner: And presumably there's some baked in assumptions that we can make about their values and what they hold to be most important.  That they got into this for their patients, for the welfare of animals, that if they were strictly financially motivated individuals, that they would be doing something else because frankly, there's a lot of easier ways to make money in the world than becoming a veterinarian, that it is a passion career in a lot of ways, when we talk to prospective partners, a big part of that is, is that Most of them are saying, Hey, I wish that I'd been able to sell to an associate, to sell to an independent veterinarian.

Bill Wagner: And I just can't find that veterinarian who is looking to be an owner right now. And I hear some of these practice owners in a moment of frustration saying, I think entrepreneurship's dead in veterinary medicine or these young vets just don't want to own. They don't have that fire to be owners. And I disagree with that assessment.

Bill Wagner: I think that. The [00:45:00] entrepreneurial spirit is still alive and well within the profession. There's a lot of young veterinarians who would be owners with the right value statement. But a lot of it comes down to the math has shifted. The landscape has shifted. The risk reward has shifted in a lot of ways. I sat there and that.

Bill Wagner: Position of judgment as a person who originally set out to be an independent practice owner and decided maybe this was a more challenging path than what I originally thought that it was going to be. When we talk to prospective partners, most of them are saying, hey, I'd rather have sold to an independent vet and say, we're off on the right track on our conversation, because that's where we feel that we align best with folks who that would have been their ideal path to the legacy of their clinic for the continuity of their clinic.

Bill Wagner: Because then we can step in and say, Hey. We are a corporate group and we own that word. We're not going to pretend that we're something that we're not, but if there's a swimming pool with different ends of it, and you've got the very hyper traditional corporate groups on one end of the swimming pool.

Bill Wagner: We see ourselves as being on the other far end of [00:46:00] fitting more in the space in between the corporate models and the independent ownership model of having this co ownership model where our local leaders are equity holders in their own clinics and are empowered to be decision makers and maintaining the standards of care and doing all these things that are very important to be done at the local level in my eyes.

Bill Wagner: I think that as corporatization continues in veterinary medicine. I envision there potentially being a pendulum swing back in the direction of entrepreneurship. I think that there's a large subset of the profession who, I think in a lot of ways, rightfully feel that there's an antagonistic relationship between corporate veterinary medicine and the profession itself, that there's been.

Bill Wagner: A lot of ways, a bit of an invasion of outside capital, outside individuals who are not veterinarians and no shade to their intentions. My co founder is not a veterinarian, but he's just a very good person. And that's why I decided to work with him of his heart and mind are in the right place. But I think there is a perception that there was a [00:47:00] land grab within veterinary medicine, uh, a lot of outside money and influence coming in, buying up large amounts of veterinary clinics.

Bill Wagner: And not being invested in the values of the profession in the way that you would like to see ownership within veterinary medicine, hopefully have veterinarians in that leadership, people from the profession, people have worked in veterinary hospital, understand the challenges that the teams face. I think that we.

Bill Wagner: Are potentially on a track of overcorrection in terms of the workforce shortage. If there's just a lot of veterinary schools that are on track to be opening up in the next five to 10 years. I think that there was a need to increase the size of the profession. I think objectively there has been a shortage over the last few years and probably will continue for a few more years, but all things in balance.

Bill Wagner: There is such a thing as too much. But I do think that a potential side effect of if we end up in a situation where there's a surplus rather than a shortage of veterinarians, the risk reward on entrepreneurship starts to look different when maybe jobs don't pay as well, are not as secure, are not as flexible [00:48:00] as they are right now, because these are all things that potentially results when you have a surplus rather than a shortage of employment, especially when the primary employers are large corporate groups who are going to take advantage of opportunities that are presented to them.

Bill Wagner: So I think that this is hopefully going to lead to a wave of veterinarians who suddenly start to see that it's worth taking the plunge. It's worth taking a risk to have a better opportunity financial future. So, this is just selfishly as somebody who feels that independent veterinary practice ownership is very important to the health of the profession on a long term basis.

Bill Wagner: I think we may see that there is some backlash against the rapid corporatization of the profession. That said, there's always going to be a place, I think, for networks. And I think that place is going to continue to grow as we see that maybe the current model of lots of small shop veterinary practices economically is Not as sustainable as maybe it used to be in the past, especially when we [00:49:00] talk about rural veterinary medicine, that there may be a need for more up and spoke models of the idea of having central larger clinics that have satellite locations that serve large regions, stuff like that, the model of care and the model of ownership in veterinary medicine and need to continue to evolve to meet the needs of the profession and the needs of clients, but that I'm optimistic for the state of entrepreneurship in veterinary medicine going forward.

Megan Sprinkle: I guess since the conclusion, I'm hoping I'm right about that. You said you had a long list of things you're passionate about, but what's the one thing that gets you really excited about being in veterinary medicine? What is it that gets you up in the morning? 

Bill Wagner: Yeah, the really fluffy answer is that at the end of the day, regardless of the seat that we're in as veterinarians within the profession, it all ties back to the welfare of animals, that there is a higher purpose, a sense of meaning to what we do, and that looks like a [00:50:00] kind of case in point to, you know, what your podcast does.

Bill Wagner: this idea that there are a lot of different ways that can look, most people think of being a veterinarian as being in general practice and, you know, being the mom and pop shop of people bringing their puppy in all the way up to being in an elderly dog and kitten to elderly cat, seeing all the life stages, stuff like that.

Bill Wagner: And that is very cool. And that's obviously representative by the majority of veterinarians out there, but there are just a lot of different paths within the profession, but they all have that common thread that at the end of the day, what we do advances the welfare of animals and the human animal bond.

Bill Wagner: And I think that is something that's cool that we can all. And again, sit in very different seats with very different perspectives, very different day to day of what our jobs mean. I've already had multiple chapter bits to my early career, hopefully early. I've got a long career ahead of me, but even through those various chapters, it's the same thing that gets me out of bed in the morning of knowing that [00:51:00] there's a reason for what I do beyond the paycheck, that I'm in a position to do good for animals, it's fun to have a job that has purpose.

Bill Wagner: It makes me very sad and frustrated when I hear many veterinarians, especially young veterinarians today say that they regret the decision to become a veterinarian, that they could do it over again. They do something else. I personally don't sit in that seat. Although I've had days where I felt like that, probably weeks where I felt like that as well.

Bill Wagner: I do feel like I made a good life choice by becoming a veterinarian. It was probably not the best financial decision. There's things that we could be doing that would make us more money. But there's a tremendous amount of joy that can be derived from having a job that has a sense of purpose. I also encourage people to have a sense of purpose outside of work, that health in our lives derives from making sure that we don't just live to work, that we have hobbies, that we develop relationships, all of these things that, uh, fill our lives in ways that, uh, [00:52:00] Going to work can't, but it's nice to feel fulfilled on both ends of things, having fulfillment in personal life and fulfillment in professional life as well.

Megan Sprinkle: On that note, the question that I like to end with is what is something that you are most grateful for? So, you as a human being, what is something you are very grateful for? 

Bill Wagner: This will also be a sappy answer, but my wife and our son, even just relevant to the conversation of entrepreneurship of taking a risk in life financially and professionally is something that when you. Attach your life to another person. They take the leap with you, whether they want to. Unfortunately, my wife has just been infinitely supportive of my various entrepreneurial journeys along the way, which has been one less thing to worry about and stress about is whether or not there's going to be resentment or concern at home.

Bill Wagner: Obviously I had to make a strong value statement to her for why I felt that I was going to be successful, what I was going to do, that this wasn't [00:53:00] just me quitting my job and going off on a random journey that I felt there was something here to it. But she just is my rock in all things. And somebody that also when I run into.

Bill Wagner: Challenges at AVP, which happens every day, we're constantly facing challenges. That's why we exist is to solve problems for our teams. So, there's always problems to solve. And I know Dimitri feels this way about his wife as well. And it's just good to have somebody outside of the organization that can be a sounding board that can be an objective.

Bill Wagner: Person that when you're just saying, hey, I'm just really struggling with this decision that you've got somebody that you can sit down and talk it through with. And my son is having his first birthday in a week. So very excited for that. And that's just been such an awesome life journey. He's knocking on wood again, that he's gone through a stage of sleeping well, but.

Bill Wagner: Certainly, there were stages where I was missing sleep. It felt very reminiscent of that school in a lot of ways, but it's been an immense amount of joy that he's added to our lives together. 

Megan Sprinkle: Thank you for listening to another great episode of Vet Life [00:54:00] Reimagined. Make sure you check out the show notes for resources to the things we discussed in the episode.

You can also check out our YouTube channel, subscribing there really helps out the whole podcast. I want to thank our sponsors who support the hosting platform, BuzzSprout, Will Hughes and FYR Consulting. I am always looking for partners who can help grow the podcast message. I hope you stay with us because I will be sharing an exciting announcement in the next few weeks.

So take care and until next week.