Webinar Wednesday Replay: Steve Curvey
Hello, everyone. Welcome back to another Webinar Wednesday. I'm your host David Hall, one of the co-founders here at GeniusVets, and today I am absolutely thrilled, very, very excited for our special guest we have with joining us today, Steve Curvey. So Steve is the chief operating officer of VSG Inc. Leading a team responsible for VSG Central Services, which supports the successful operation of every one of the individual veterinary management groups, so what you much better know them by is VMG. Steve's team is composed of veterinarians, business leaders, event planners, administrative professionals, each dedicated to the needs of VMG members.
So one of the first things I really love to ask every guest on our show, is if you can perhaps share what things you've personally found that you'd say play an important role in helping to get things done? I'm talking about, you have morning routines, healthy habits, organizational discipline, approach to tools, or colleagues, and teams that you rely on to support you. How do you actually get all this done? Because, it's an incredible thing you're doing.
We've got an outstanding staff. I don't do it all by any means, and we are structured as an organization to be somewhat lean and efficient. We've got a total of 30 employees in a couple of key departments, one of them would be operations, others would take care of nearly 150 meetings of veterinarians and veterinary professionals at least 40 here. The other would be group development and member services, and we've got two incredibly efficient leaders that lead those two groups.
The other big area would be our commercial programs, our purchasing program, one of the four most purchasing programs available to veterinarians in the profession, and that is also run by a team of very, very experienced professionals. We rely a lot on the talent of others that are within the organization.
Yeah, so we've got more than 50 veterinary management groups now and they meet twice per year typically under normal times. We've got an awful lot of virtual meetings in the fall of 2020 as you might guess because of COVID. But if you have 52 meetings twice per year, then you've got over 100 meetings of veterinary professionals, veterinary leaders within the veterinary management groups. And then ad hoc meetings that would include professional development, and other internal meetings would bring it obviously past 150. So we're a meeting intensive organization, and that's just the way we've been structured and the way we run.
Steve if you can tell us about Veterinary Management Groups, what's the mission of the organization, who's it for, what are the benefits for members?
You bet. So I would say to the audience that is tuning in that VMG has been a fairly well-kept secret over the years. Don't feel bad or be surprised if you haven't heard of us, but we started back in 1984 with a single group and have grown from one group to 52 over the course of 36 years or so that has transpired. Each group is comprised of about 16 to 20 members that are dedicated to the success of each other's practices.
Success can come in a lot of different ways, it can be to improve the practice of excess cash flow, which will have an effect on short-term and long-term profitability and practice value. It could be the improvement of quality of client service improvement, quality of patient care, and also improvement of the quality of life of the practice owner and the member practice team. We have so many reports that include words like exhaustion and stress, certainly affected a lot by curbside check-in, and some of the challenges that practices face today.
But I think as a whole, this profession has a lot of veterinarians that feel like they're operating sometimes in isolation or alone, and when you are part of Veterinary Practice Management group you're never alone, because you've got other members of that group that are going to be dedicated, not only to the professional success, but also to the professional success of those that are in it.
Our mission, simply put, is practice success through collaboration. Where you have these members who come together, they're all non-competing members and they can really contribute to whatever is needed to address the issues and the opportunities that are faced within a group.
We've all been through it. You can learn from a book or you can learn from a whole series of didactic presentations, but if you're learning shoulder to shoulder with somebody who's going through the same things that you are, you will probably learn it at an accelerated pace for sure.
Yeah, so when you said you have 52 groups now, how many total members, and how many members are in a group?
So there are roughly 1100 members, David. Because of the multiple practices, many of the members so the total practice count is a little over 1500, I think 1540. The one immutable measure when you look at the size of an organization veterinary medicine will be the full-time equivalent veterinarians that are practicing within these buildings, and we're up to somewhere in the neighborhood of 5,600 full-time equivalent veterinarians, which according to industry estimates would be about 10% of the overall small animal, equine and mixed animal space in the U.S. and Canadian markets, by the way.
We've got members from all 50 states, and in four out of 10 provinces in Canada. And coming back to group size, typically 16 to 20, and it depends on the type of group you form, and as you might guess with 52 groups there are a whole variety of groups, small animal, primary care, mixed animal, equine, we got two academic groups that comprised of key clinical and administrative staff from veterinary teaching hospitals, we've got a feline group and we've got five going on six AHA accredited groups. Again, a lot of variety, and hopefully meeting the needs of veterinarians throughout the profession.
The AAHA accredited group, I've spoken to a number of VMG groups and met with them, and I found maybe those were the AAHA accredited groups, but I found most of those practices were AAHA accredited, is there something special about those specifically accredited?
So we were started back in 1984 by an immediate past president of AAHA, and although AAHA's been a great friend of ours, and we are an AAHA centric organization, I believe that 40% of our small animal practices are AAHA accredited. The AAHA accredited groups are a little bit different. Within those groups, I'd have to go back and look at the accounts, David to tell you how many members are in them, but there is a requirement that those groups have all AAHA accredited hospitals participating in them, and they're also a little bit different because those groups have a practice leader in the form of a practice owner or veterinarian. A company typically by a practice manager, some of the key staff members that would typically also be nonclinical. So it's teams of two, and if you have teams of two, we try and keep or allow no more than 20 seats to be built into the group, so it's typically 10 groups of two instead of 20 individual members. So again, just a little bit of a different approach to it, but that's how we run with the AAHA groups.
I believe that we had nine groups that met in the early spring of 2020, they were predominately equine groups, and because of the seasonality of their workload, they typically would meet in January or February, but after that, every meeting for every group went virtual, and it's the same way in the fall. We've got a little bit of a resurgence in meeting activity where there are some groups that are meeting in a sort of a hybrid fashion. There's a group that started yesterday where 10 members flew into a location in the Denver metro area, and the other 10 members basically participated virtually. But it's certainly been different, much more virtual presentation of tenants and meetings throughout all of 2020.
Has the frequency of the meetings been bumped up? Because it's kind of hard to sit for three days in a virtual space.
It has with some groups, and we're all kind of learning the new reality and waiting to define what the next normal looks like, but we've got some groups that have met every month, and their work trying to basically fit content into a more digestible pattern, and we've got other groups that have tried to meet for four to six hours per day for the two and a half days that might normally have reserved for a traditional meeting. But the net is over our reduction the total amount of meeting time and in an attempt to find greater efficiency in absorbing or digesting the content that they set before themselves.
When a veterinary practice owner first joins VMG what can they really expect in terms of the curriculum? I know that during the first several meetings, the first couple of years, there's kind of a set curriculum especially for a new group, but you also have some members that join groups that have already been going for a while. So can you talk a little bit about what's to be expected onboarding and getting started?
The product so to speak that we provide to VMG members today is the culmination of 36 years of experience. People like Dr. Paul Glouton, who's on our staff today, he's the senior advisor, put together a template of programs for the first four meetings of a new group, but what we try and encourage is home rule, and self-determination when it comes to groups determining what the content or the subject matter is that they need to address within their meeting. Essentially it's going to be a reflection of the issues of that group basis.
For the first four meetings of a new group, we typically start with basic practice finance, and then we follow that with a meeting on human resources, follow that with a meeting on leadership and just kind of control and command of an enterprise, and then the last meeting interchange with the third, it would depend on the time of year, would be one that breaks down profitability and key management practices by having every member undergo a calculate value report, which looks at several years of past performance, and it really looks at the underpinnings of practice success from purely a financial standpoint.
Those are typically the first four, and then we would encourage the groups who develop their agendas, working with their facilitator on a go-forward basis.
What are some of the other topics that perhaps once they get through the main curriculum that they would have access to and dive into?
Sure. By the way, you mentioned Dr. Drake, a great example of a cherished member of our organization, and I didn't give them this before, and you would expect me to be partial, but we are primarily a referral-based organization, we grow through referrals by other members, and there is a quality component to that, that we take great pride in and Dr. Drake and the Drake Center are great examples of some of the best and brightest, most respected, most admired practices in America, and we're very proud to have them. You mentioned Katz, Sapper, and Miller, and Terry O'Neil, I think they are a good example of the talent that we have at our fingertips to bring in front of our groups to talk about those topics and subjects that are highly relevant to them from a business or a medical standpoint.
Short term David, some of the content that we see at meetings, or just how to adjust to the new realities of curbside check-in, some of the lean staffing issues that are forced upon practices because of the shortage in labor, and some of the disruption caused to workforces associated with COVID. Some of the mainstay topics that we see in any normal year would have to deal with those largest call centers or revenue centers within a practice. Human resources, the importance of positive cultures, and the mitigation of risk associated with employment practice liability. Leadership, the importance of understanding the growing enterprise that typically practice owners they are the CEOs and the captains of their ship, and leadership become a very important quality, especially as practices get bigger and their staffs grow.
Inventory control and all things related to cost of goods, another huge portion or element of other practices, P&L very important to drill down on that. And then topics especially with many opportunities come up. Things like telemedicine right now has become very big in a post COVID era. I'll just serve that up as an example of a topic that may not have been important five years ago, but all of a sudden it's emerged as a very big topic. It's a good example of an agenda item as being inserted into a lot of agendas in the fall meetings.
Can you talk a little bit more about that process for vetting the information, the vendor content that would come through?
I provided us an example that we've got a group that started a fall meeting, a hybrid meeting in Denver yesterday. The meeting host rotates every meeting. And whenever there is some meeting host putting on a meeting, you can probably understand the pressure that they have to produce a good meeting. There's a little bit, I wouldn't call it a competition, but certainly peer review, and peer inspection that's involved. That really makes each member meeting host want to put on a great meeting.
But they don't do it alone. They will work with the executive committee they have with their group, the executive committee is usually comprised of four leadership positions for a group, and they'll work with them to basically vet the content for a meeting.
You know it's interesting, you don't hear a lot of negative reviews for the meetings, and I think if some of the content did not work, then you'd hear those types of negatives. Typically, it's a group of members that are coming together they accept it, content, and the agenda setter that is assembled and they go into it with a very positive attitude about that material.
I think that enthusiasts would go to a meeting is also partly related to the personal satisfaction they get being able to go and share some of the issues that they face with a trusted group of colleagues. So there's kind of business of study groups as a business component, there's also a personal component, that our members look forward to as they get ready to go to their meetings for sure.
There are a lot of these esoteric benefits. Those things that maybe don't make their way into the brochure, but are such an important part for members that they get out of that. Can you speak to some of those things?
Yeah, I think David, one of them is if you've worn a white coat and practiced within a hospital for 25 years, you do get to the point where you kind of wonder if there's something more, and I believe that I probably won't articulate this well, but know an interesting one is something greater than the four walls that contain you.
When you throw in with a VMG group, you've got an opportunity to contribute this success to other practices, and that really is something that drives a lot of our members. Like, say the esoteric benefits would be just the friends for life component. You're going to share some of the experiences you have in your hospital, and it's amazing just how quickly those bonds form and how long they last. Somebody may sell a hospital and get out, but they'll be forever linked to that group kind of as an alum through alumni type meetings or through created out of conversations that can go on into infinity.
With all the turmoil that veterinary practices have been facing this year in light of COVID, what are some of the bigger challenges that VMGs identified among its members, and what has VMG been doing to help its members work through those challenges?
Probably the biggest one that emerged before COVID became a problem was staffing. Just trying to find clinical and paraprofessional help. We would go to meetings and members would stand before us, and say this is a lane that we got to have you participate in. So we were evaluating options, we recently introduced a service that would provide assistance for hiring staffing, and we realized that was a big problem coming into COVID. And then all of a sudden it changed a little bit, I sense, in talking to a lot of members that the workload, strategic workforce planning changed a little bit when they went to curbside check-in, there were efficiencies that they had before that they weren't able to express or apply today.
There were numerous employees in various practices that decided they didn't want to be in touch with the public or didn't want to continue working and some of those employees quit and probably forced some of our practices into a lean approach that they didn't anticipate. Human resources again is one of the most important and critical factors when it comes to delivering a care scenario that I see as an emerging challenge. How do we deal with this?
It's something I think our practices have done extraordinarily well. It will remain a challenge for as long as we have a high demand for veterinary services and a relative shortage of veterinary talent.
David: Yeah, you know this has been an incredible topic that's come up in virtually every interview I think we've had so far on this show. Maybe not every single one, but most of them it's emerged and we've had great insights from people like Dr. Peter Weinstein, executive director of the SCVMA, I know you know Peter well. Where I was surprised by his response, really focusing on two issues, one being veterinarians sticking to their lane in the practice a little bit more, like do the things a veterinarian, only a veterinarian can do. Utilize your vet techs to do the things they've trained to do, and that sentiment has come up in multiple interviews, now just Peter’s.
Also, underserved communities. And you look at areas, urban areas, areas that have been largely overlooked in the veterinary profession, not only is there pools of people there who are intelligent or ready to be the next generation of doctors, but practice owners, and communities who need service and all of that as well. A lot of growth to happen there. It's been very interesting to hear a lot of those responses. And some people identifying, I don't know what the number is now, but I know it at certain times this year report is very, very high unemployment numbers due to COVID and certain industries being shut down. So that's a big pool of talent that now can be shown this is a great industry and a great career you can have here.
Steve: David, also the stress associated with home care, pulling some very valued employees, I was very impressed because they've got to educate their children. Peter Weinstein, he's a talent, and we've been working with our practices for well beyond the time that I started, which was 12 years ago to leverage the staff to the best that they can. And it's been one of the central tenants of operations from our perspective. And yeah, I think a very valid concern with the democratization of vet care for underserved or elements of our society. Heck, all the way down to our neighborhoods and communities who really need pet care and not necessarily in a position to afford it. There's a lot of time and a lot of effort by our groups to address concepts like the morality of therapies and things they can do to help elements of society, that really need help. These are good people performing good work like you find a way to make it work. I think veterinarians as a whole are very charitable when it comes to doing those things in their communities.
There are challenges, and I love that you're talking about things like the morality of actually charging the fees that you deserve to be paid as delivering medicine, and the challenges that brings. A lot of the low self-esteem that frankly that the industry might carry with it. A lot of doctors, not charging the fees that they should, or it's showing up in other ways, like incredibly high suicide rates. Being a massive issue. Is there anything VMG is doing to address that?
I think we try and elevate the consciousness or at least the idea that we need each other more now than we ever have before with some of the pressures that our brethren in the veterinary profession face. It's an important consideration. We started an employee assistance program, David, about two years ago, and have promoted that widely within our organization, and I think some of that. Also, when some of the organizations' state associations, for instance, found out that had an EAP program, they came to our provider and basically said, "Hey, can we apply this to the name a state VMA?" And we absolutely said, "Please. Offer this as far and wide as you can. If it helps somebody in need." It's an issue, we're certainly aware of it, and ready to come to anybody's support that we can whenever we can.
There is one other topic I'd like to get your take on. At GeniusVets our primary mission is to help independent veterinary practices thrive. And it's very aligned with the mission of VMG, of course, one of the most notable trends in the veterinary industry over the past several years has been the consolidation of independent veterinary practices with large corporations. Sort of gobbling up the industry. I would really love to hear your thoughts on the trend to consolidation, and this corporatization of veterinary care.
You bet. And David, one comment I'd make, we're big fans of veterinary ownership in practices. We actually have a couple of corporate roll-ups within our organization, they are a lot of organizations that encourage partnership and retain veterinary ownership. And I just wanted to make the point that corporate consolidation is a hard trend, and I think we all not only see it, but I think we are getting used to the idea that it's not going to slow down anytime soon when the average practice owner is 61 years old, they've been wearing a white coat for 30 some odd years, and they've got an opportunity basically to consolidate some of the gains and the value of their practice, and probably many instances continue to work. So it is a hard trend, and we're not critical of it, but we've certainly had to adjust to it in terms of group development at veterinary study groups.
We estimate that we have lost since 2012 when we started measuring it, somewhere in the neighborhood of 500 practices now that have included more than 1,000 full-time proven veterinarians, and probably close to a billion dollars in total veterinary practice revenue if you look at the number of veterinarians that have gone from the independent practice side over the corporate side.
So it's a trend that we're very, very familiar with. We certainly don't make any judgments associated with it, except to acknowledge that it's a hard trend that will continue.
David: Not every corporate entity is the same. We have some out there that we think are really practicing at a high level, they're running and a lot of them aren't keeping that veterinary ownership in a practice, and have some really interesting ... There are almost as many business models for this as there are companies who are doing it. And so by no means are they all equal. But it's a trend that we are watching and then we find somewhat disturbing and obviously coming from a place of having one of our founders be an independent practice owner that several of those organizations large consolidators have been chasing and making offers at it, so watching what is happening, it's understandable. I thought a few weeks ago I had on the show Dr. John Tait, treasurer at VMG for those who are watching. A brilliant, brilliant man honestly. Nothing against you Steve or myself, or anything. I think he's probably the smartest person in the entire veterinary industry.
Steve: He's an overachiever for sure.
It was very interesting talking to him about this concept because he was talking about alternative exit strategies and how certainly some of these large corporate entities are bringing in these multiples that are very difficult, if not impossible for a typical associate veterinarian to be able to match, but looking at alternative structures and exit strategies that in a lot of cases can allow that transition to an associate vet and even end up better in the long run for the exiting owner… In our conversation leading up to this, you had mentioned the transitions program that VMG has. Could you tell us a little bit about what's the transition program about?
Sure, just comment on Dr. Tait develop programming in conjunction with some other clinical leaders, veterinary leaders here at veterinary study groups and he entitled it consolidation counterpoint. And it wasn't to say that a practice owner should never sell to a corporate, but for those that were looking for ways to transition a practice to associates, there might be some creative ways you can structure a transaction that would enable you to do that, and maybe even in the long term come out ahead financially, and he listed 12 different ways you can transition a practice in that program, and it was if anything it just provided a practice owner with alternative use of what he or she might do.
The program that we developed, the transition services program also features Dr. Kate, and three other advisors we call them, one is Terry O’Neil, you had mentioned before, another one is a gentleman by the name of Steven Young that deals with personal wealth management, and lastly Tony Aaron, partner of Ice Miller Legal Firm in Indianapolis, Indiana. That's developed a very successful veterinary vertical over the... he has a lot of expertise in the area of that medicine and practice ownership.
But between that group of four advisors, a VMG member would have access to any one of the four, or all of the four to help them with decisions related to transition. John Tait and Terry O'Neil would provide an opportunity for them to look at the operational readiness, are they really ready to do this, and can provide some advice and some counsel as to whether or not it's the best move to make at any particular time.
Steven Young obviously would work with wealth consideration, tax management, investments. Are you going to outlive your money? Are you ready to do this financially? And then the legal side of it might be in the spectrum of sales contracts, and an examination of some of the contracts or agreements that exists within the ownership currently of a veterinary practice.
So it's kind of a service that we developed, David, that addressed the hard trend of consolidation, the hard trend of 61 year-olds looking for what's next. And it's a great service to offer our members. We would encourage them to of course use if they thought they needed it.
There are two other topics I wanted to touch on. One, we were kind of talking about COVID and how it affected the groups. You typically VMG has a congress that would happen every other year, and I believe it would normally be happening in early 2021 under normal circumstances. That's one area I hadn't seen an update on, or anything like that, what's the current plan going into the next VMG congress? What should we expect?
We just finalized our plan. Congress is a biannual event that's an invitational, instead of groups of 20 we invite all VMG members and their staff to come to it. Not everybody shows up, but we had 700 people in Orlando, Florida in early 2019. And to plan any biannual event is for every other year, so it would have been February of 2021. Because of the uncertainty associated with COVID, we moved that back a full year. I don't remember the exact dates, but it will in February of 2022, and we hope to have a great program.
During the congress, as you know, from having attended it in the past, we've had keynote speakers that address some of the current topics that are of interest to VMG members and we have been able to carry forward the speaker agreements to every speaker we had scheduled for this coming year to be available in 2022 as well. And as long as their content is still relevant there are times when you'll see a very similar lineup for what we had planned for this company.
Are you looking to grow? And how much you want to grow by. What are you doing to grow? If somebody wants to get involved, can they reach out to you, do they have to find someone to get referred, or how would that work?
Yeah, thank you for asking that. We've got standards in our organization as anybody would, but we're not an elitist organization by any means, and we're not so critical as to really try and keep membership low, but we do acknowledge that we're a relatively slow growth organization because starting a brand new group requires a certain level of high touch, and we've never tried to mass-produce groups.
We've got two new groups that are going to be opened up for candidates to come into them. VMG 67 and 68 are the numbers. One of them will be for three and fewer full-time equivalent veterinarians the other one will be for four and more. So kind of smaller, not small, but smaller compared to the bigger four.
The referral component really comes out whenever a member of an existing group leaves. We require unanimous approval from the group to bring a new member in, and referral has to be an important component of that.
For the new groups, as long as a veterinary practice has a good practice, well run, ethical, from a biographical standpoint, as long as these are people that are coming up with an idea that they do have an interest in contributing not only to the success of their practice but also to those of the other members that are sitting in the room with them. It's pretty easy to get into a group, and typically we'll add two to three groups per year, that's been the track record over the course of the last 12 or 15 years, and we look to continue to do that into the future.
Consolidation has got to run its course. There's no question that a lot of practices are being bought by corporate consolidators, but it still leaves a vast number of independently owned practices that should have an interest to come into a group like this to optimize the value of their practice and their practice ownership experience over time.
One of the things we do to wrap up every one of the interviews here in this inaugural season of our Webinar Wednesday interviews is with every guest we play a little game where we get to know you, I want to get to know you just a little bit better as a person. Alright, this is a weird one. Would you rather tour a wax museum or an observatory?
An observatory. Wax museums kind of creep me out a little bit.
Would you rather dine with celebrities or with geniuses?
Geniuses. It's just all about learning. Learning from people smarter than me.
Who would you hold up in that category? Who would you like to be at the table?
It would be a list that would almost be too long, and I would almost hate to identify just one, but Einstein. I'd like to find out if he was conversational. How would he translate the knowledge in his brain to common speech? I think he would be wonderful. Some of the great leaders of some of the great countries, well they're all great countries, but some of the great leaders in the world past and present. Some of the great minds in our business today. The Bill and Linda Gates Foundation, I would love to sit down with Bill and Linda Gates and meet them and learn a little bit more about them. It's a long list. I probably should sit down and write it out at some point.
Would you rather go without electricity or running water for a week? I told you they were thinking.
Probably running water. Well, you can buy bottled water. I live in Atlanta, and you can't get through an Atlanta summer without electricity, without air conditioning. I could last without running water for a little while. I could live on bottled water.
Would you rather be an excellent cook or have a significant other that's an excellent cook?
I'd flip a coin on that. I kind of believe that there's enough room for two people in the kitchen. I like food, so I think it's important that we're both excellent cooks. Both.
You’ve got to leave me a moment at least to reciprocate on a compliment that you made to us. You basically gave us credit for contributing a lot back to the profession, but GeniusVets does as well, and I wanted to tip our cap to you, and some of the work that your organization is doing to help optimize the performance of veterinary practices, and it's been a good association, our association with GV and we certainly appreciate that.
David: Thank you so much, Steve. It really means a lot to me. We certainly try, every day we have that focus as our mission, we take our mission very seriously, we make every employee not only memorize it, but talk about it on a pretty regular basis, and compare their own work to it, to the values that we really hold dear, and every decision we have to make, we actually make that as a standard does it meet these criteria that we said as an organization we're going to meet. Because we know if everybody in the organization is striving to meet those same challenges, those same ideals, we can sit back a little bit, make our jobs a little bit easier, and put that faith in knowing that they're going to run it that way. We certainly try. Thank you very much for that.
Steve, do you have any shout outs or any suggestions potentially to people viewing? Who should they be following? What should they be looking forward to? What should they be doing? How can they be reaching out to you?
Sure. We have a website, www.veterinarystudygroups.com. And we would invite them to contact us through the website. That would be the easiest thing, and we would look forward to hearing from them, and we hope we do get some inquiries.
VMG is not a well-known organization. We don't advertise a lot, but we've got a lot of outstanding practices throughout the profession that participate and there's always room for more. If you're looking for a little bit something more, and the short term, long term value of your practice, anything that would contribute to a positive practice culture, anything that would help you to adjust to meet some of the challenges you're facing today, it might be a pretty good choice. Thank you David for having me on today.
David: Thank you so much for taking a little bit of time out of your incredibly busy schedule. I really hope that we can spread your message here far and wide. Not only is it going to be on this Webinar Wednesday, but we are going to be promoting a full-day virtual event here coming up in November. So that's going to be a great outstanding opportunity to once again for us to get this information out in front of the people who need it.
This is David Hall from GeniusVets wrapping up another Webinar Wednesday. Remember, any veterinary practice owner that's watching today, you have a full-page profile already live on GeniusVets.com that's featuring your practice, telling the world all about you, go check and make sure that the information is correct, it's free to claim, and we'd love to hear from you if you're interested in any of our other services, or have any questions. All right, thanks so much, everybody. Have a great day.