Burnout. We know about it. Many of us live it. Is there a solution?
For this episode, I’ve invited Dr. Ivan “Zak” Zakharenkov to share with us his research on burnout in veterinary institutions-- all collected from his dissertation and experience in 35 different hospitals across Canada. With his extensive background, Dr. Zak aims to crack the code and build a new methodology to address veterinary groups’ acquisition, integration, and improvement; all while keeping employee experience as the top priority.
Could consolidation really be a solution to some of the issues in vetmed? My opinion has definitely changed after learning about a possible burnout-proof mindset for corporate practice transitions. I am interested to hear what you think!
Things we mentioned:
About Dr. Zak:
Dr. Ivan Zak has earned multiple accreditations in veterinary medicine. After graduating, he worked in 35 veterinary hospitals across Canada, where he was inspired to create Smart Flow, a first-in-the-industry workflow optimization system. Smart Flow was subsequently acquired by Fortune 500 company IDEXX, where Ivan became General Manager of the Software division. After consulting 500+ practices worldwide on workflow optimization, he dove into studying the psychological triggers of burnout and business methodologies that veterinary organizations can apply to eliminate them. Ivan obtained an MBA degree in International Healthcare Management and wrote a dissertation “Implementation of lean thinking to improve the employee experience.” Today Ivan is leading VIS, helping veterinary groups systematize acquisition, integration and improvement of practices while preserving the employee experience.
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Hey there, it's Dr. Stacey Cordivano. I want veterinarians to learn to be happier, healthier, wealthier and more grateful for the life that we've created. On this podcast I will speak with outside of the box thinkers to hear new ideas on ways to improve our day to day life. Welcome to The Whole Veterinarian. Today's guest is Dr. Ivan Zak. Dr. Zak has earned multiple accreditations in veterinary medicine. After graduating he worked in 35 veterinary hospitals across Canada, where he was inspired to create Smartflow a first in the industry workflow optimization system. When Smartflow was acquired by Idexx, Ivan became the general manager of the software division. After consulting with over 500 practices worldwide on workflow optimization, he dove into studying the psychological triggers of burnout and business methodologies that veterinary organizations can apply to eliminate them. Ivan obtained his MBA in international Healthcare Management and today is leading VIS. Veterinary Integration Solutions is a company that helps veterinary groups systemize acquisition, integration and improvement of practices while preserving the employee experience. This discussion was certainly outside of my normal realm, but I learned a lot and I really appreciate Dr. Zak's insights on burnout and also corporate consolidation. I hope you find it as interesting as I did. Questions about finances? Vincere Wealth Management is the solution. Isaiah Douglass is a partner of vincere wealth management and the host of the veterinarian success podcast. He is a fee only Certified Financial Planner. And he and the Vincere team are dedicated to serving veterinarians in all stages of their careers, then seer can assist you whether you're a new graduate getting started or an experienced that trying to navigate selling your clinic and moving into retirement, you have enough stress in your life, finances no longer need to be on that list, you can find a link to download their free resource called a financial guide for veterinarians on my website at thewholeveterinarian.com/resources. Thanks again to Isaiah and Vincere Wealth Management for their support. And now enjoy the show. Ivan, thanks so much for taking some time to sit down and chat with me today. How are you?Ivan Zak:
I'm good. Thank you for having me.Stacey Cordivano:
So I believe I recently heard you say that you are dedicating the next 10 years of your career to combating burnout in the veterinary field. Is that correct?Ivan Zak:
Well, I'm estimating 10, but many factors involved...if I'll be alive and but I think that it's a big enough chapter sort of over your life and career. And I think I went through this training that was on flow. And if you're familiar with the concept of flow and the happiness associated with how much flow you have in life, but I went through that training, specifically in sort of anti burnout as well. And we needed to set the massive transformative goal for yourself. So for me, it is trying to combat burnout in the veterinary domain. That's what I want to do.Stacey Cordivano:
Amazing. So with that little tidbit and listeners minds, can you tell us a little bit more about your background, and then a little bit more about how you got to this place in your career?Ivan Zak:
Yeah, so vet by trade, originally from Ukraine, and I repeated the training in Canada, because nobody cares about Ukrainian training, and then somehow ended up building the first diagnostic lab in Russia, came back to Canada worked for 12 years in your small animal, really respect to equine practitioners like yourself, but I'm afraid of horses and did that for about 12 years. Did a lot of locums, burned out and had to leave the profession for about six months seek professional help. I was in a pretty dark place, got through it. And then at some point, shifted gears and wanted to solve problems in the workflow. So I built a product called Smartflow. Some listeners may know it helps with the efficiency and the workflow in the missionary emergencies and big hospitals and then sold it to I worked as a general manager of their software division, and then left itix finished my MBA focused on burnout in the thesis for the dissertation. And then now I'm running a company called Veterinary Integration Solutions that focuses on optimizing veterinary consolidators with the burnout prevention in mind, which I think is really relevant these days for both business and the wellbeing of veterinarians.Stacey Cordivano:
For sure. I do want to get into how your company does that. But first, I was hoping you could talk a little bit about the burnout study you did for your MBA and sort of some of the results you foundIvan Zak:
My goal there was to a understand Are we burned out? Because everybody talks about it? Obviously, it's a very important topic. But I just wanted to say, are we or are we not? Is it like a shark attack that everybody hears about? And it's big news, but it's statistically irrelevant, or are we burned out? So that was number one question I wanted to answer. And then just to get a little bit of into detail, what age is more involved in what part of the veterinary clinic or profession, because everybody's talking about veterinarians, but as we found out, it's actually technicians that are burned out more than the veterinarians. And what was also surprising to me, that younger veterinarians around 30 plus are burnout more than more senior and sort of baby boomers generation. So yes, we are burned out, the younger vets are more predisposed. And then the techs are more burned outn than that. So those were the findings in dissertation that was sort of the research part. And then I was trying to find the business methodologies that other industries apply in specifically human healthcare. And I spent some time researching that, and I found LEAN is one of them. And then I hypothesize, maybe by applying some sort of management methodologies, we could prevent burnout. So that was sort of the study.Stacey Cordivano:
Great. So any indications or further insight into why younger veterinarians are more predisposed to burnout?Ivan Zak:
Any research usually leads to more research. So I think that this is an opportunity. I'm trying to do this this year again, and do a little bit of a different slice with different questions. But using similar tools, we use professional fulfillment index (PFI) and that was designed in Stanford. And we didn't ask the reasons, but I have hypothesis that I would like to prove. And I think that younger veterinarians, to me, it is something to do with goal setting. I actually think that veterinarians are extremely goal oriented people. And it's a very refined selective process since the time that you are deciding to be a vet, because I'm sure you heard it from everybody, you talked to all I want it to be a bit when I was 10 years old, or something like that. And those that are veterinarians, a lot of them say that I decided to be a vet when I was eight. And if you think about the goal setting of that child, to actually go through all of that finish high school with great marks get into a bachelor in sciences do really well there apply 10 to 13 candidates proceed. Hardest school comparable to med school and the law school and then graduating. So that goal was 15 years ahead of you. And when you hit that goal, and you show up in the exam room, every day after that, and it's rinse and repeat every single day like a groundhog day. I think that because we don't set the goals or help the students to set the goals beyond graduation. I think this is where we fall off the cliff. And if you'll see it, it's about first sort of five years into graduation. Yes, it's fun for the first two, three years when you're seeing cases that you learned about in school. After that I preferred emergency medicine because it's different. But after you cut, you know, 50 or 100 spleens out it's not different. It's the same. There's other factors. I mean, burnout is not a single factor. But I think that the goal setting is very important component of positive psychology. And if we don't teach young veterinarians how to set goals or help them when we hire them, I think this is one of the main reasons but this is a hypothesis. This is not scientifically proven. I am working on trying to prove that, but that's sort of what I think.Stacey Cordivano:
Yeah, that's really interesting. I can definitely personally relate to that. A lot of the people I've talked to on this podcast that five year mark is a rough mark for them. For me personally, mine was pushed back a little bit, I think, because I opened my own practice. So there was a lot of goal setting within that earlier than I had expected in my career, mostly because of the time I graduated around the recession. But when I hit the eight to 10 year mark of my practice, I was really kind of floundering. And it wasn't until I sort of discovered some new goals outside of work that I found myself in a happier place. So I anecdotally support your hypothesis.Ivan Zak:
Thank you.Stacey Cordivano:
So as far as the other structures you pulled from human health care, the lean strategy, can you talk a little bit about what that is and how it might apply to veterinary medicine.Ivan Zak:
So I started thinking about this burnout. I didn't know what to do with it, but it was sort of intuitively something I want to learn about. And then I thought, How do I find about different things they do in human medicine. But when I built Smartflow, I was thinking a lot about the workflows. And then I thought I came on to something new, because I was eliminating sort of stupid steps in the workflows in the hospitals. And it turns out that Henry Ford did it before me. So there was no discovery there. And then taiichi Ohno in Toyota, so it's really the sort of lean methodology that Ford and Toyota used and then it spread to other industries. And then it came to healthcare and then in healthcare, some other countries implemented and it didn't go well. So The NHS in the UK, which is a sort of centralized and the social medicine like we have in Canada. They did it but it left a bad taste because they literally thought more about the waist cutting, which turned out to be people is the main goal of it. So I met with a gentleman, John Toussaint, who was the CEO of Wisconsin healthcare system for a while he also wanted to implement something at scale to motivate people. And he converted lean from the manufacturing industry and had specialists kind of help him in that. And it worked. And it worked well for some time. But then after two, three years ago, it wasn't working. So he decided to redesign lean from other industries into more principle driven management system. And a lot of those principles really helped to sort of redefine how people look at General leadership. And there's six main principles that he introduced. And the one that really, really resonated with me was that lean is the respect for people that do the work, the most important thing, especially in healthcare, there's such a bit hierarchy of management that people at the sea level, they don't know how those nurses or how those doctors are doing their day to day work. So one of the things that they do, they visit, basically the floor and the CEO, I've been in Boston General, I've been in San Francisco General Hospital, they use lean at all the levels of organization, their CEO does once a week walk with the stand up in the morning hurdles, the stand up meetings, and they listen to what's happening. They understand how people do the work. So the system is really understanding how do the frontline people that don't mean front desk frontline, like doctors, nurses? And how do they do their work? So management can understand that? And then how do they news of changes and continuous improvement? trickle up the hierarchy tree is very interesting. I visited a conference, they have an amazing conference, the organization is called Catalysis. They build this organization based on Lean principles. And it's global. There's quite a few hospitals, I think over 100 in us, and then there's Singapore and the UK. So they really made changes, and it helped to inspire people. And I was trying to think Can we do something like that in big chain medicine, there's some things that I realize we can't. And because our hospitals are not 1000s of people, or hospitals are 20,30,50 if you're bigger. So to implement something like that is scaling is a privately owned organizations you can't really come in, you have to sort of sell it to someone and they need to want it. So to scale that it will be very difficult. So I bumped into that immediately. But then I realized that we have this new phenomena and not phenomena. But this is what's happening in the industry. Now the consolidation, and then consolidation is aggregating multiple hospitals with the hierarchy and the management structure. So I thought if they would care about people, then there's something that we can do by implementing it in the consolidation. But the question is, do they care. And for the most part, the consolidators don't, because it was interesting when I was working for itix, I met this sort of tree of interests. As I was trying to design How do you sell to consolidators software products and things like that. And I was trying to map from the pet interest to owner interests to visioneering interest then to consolidator, and see are the goals and interests aligned. So if you think about it, pet wants to feel better, we're talking about sick pet, the owner wants the pet to feel better, the veterinarian wants the pet of the owner to feel better. And the consolidators want to make money. So there's a slight disconnect, and I don't blame them.Stacey Cordivano:
The alignment stops with a veterinarian,Ivan Zak:
I don't blame them. That's what they do.Stacey Cordivano:
They make money, right. But if you are making money in a certain domain, and you want people to be happy doing so you need to have the purpose behind it. And you need to align these people around the purpose that you have in the organization. And that is something that we don't have in the current consolidation. So that's again, where vi s came about. I said, Can we become thought leader and influence consolidators, and say, actually, it depends on the people that work for you, and whether they're happy if you will make money. So now all of a sudden alignment is happening, because that pivotal moment. And that's what's happening right now is when we have the abundance of vets, and there's demand is much higher than supply. So there's scarcity of vets. Vets are paid ridiculous, well, ridiculous to the time when I graduated, it's like doubled in more, and they're still not happy. They don't want to work for these consolidators. And if you're losing a veterinarian when they're buying clinics, they're talking about increasing the margin. And they're doing it by savings in the inventory and proven marketing and consolidating benefit packages but all of a sudden you have someone leave the hospital your half million down, because it takes 10 months to hire a veterinarian today. So now all of a sudden, it's connecting.Stacey Cordivano:
Right I want to clarify because I think In general veterinarian world, when you say consolidators, you're talking about corporate owned, we would say corporate.Ivan Zak:
So definitely not groupf of 5 hospitals, the people that own 5-10 practices organically grown bought another one bought another one that's not conciliator consolidator that I've mean consolidators private equity backed with a window of three to five years to return money. And they will drive land grab of buying clinics rapidly in three to five years and then flip it to someone elseStacey Cordivano:
Got it. Okay. I just wanted to clarify that for people, because I don't know that that's the term we talk about a lot. But I do think we hear a lot about high salaries for new grads or recent grads from corporate owned practices, but maybe not being so happy of a place to work. So you said that kind of all this research and study into Lean management is how VIS came about. So tell us a little bit more about what the goals or mission of your company is currently, and kind of how that relates to decreasing burnout overall?Ivan Zak:
Sure, well, our mission is to inspire veterinarians to do the work they're passionate about, that's really what we're after. So that's the main thing is to actually create an impact, where we can create an environment where the vets are working in the situation where they love their work, because events are passionate about treating pets, that's what they came to us with. But if they're doing it in a terrible environment, or they're doing it for the wrong reason, then it becomes a vehicle to generate revenue for themselves to feed their family. But we know that statistically, if you're making 75k, then you're actually have all the needs met. So anything above it can stimulate you statistically for about two months, and then you forget about it. So but throwing money at veterinary, I'm happy for vets, because we should be paid more. But throwing more money at them is not gonna make them happier, neither will retain them, there's 40% of veterinarians that would not recommend our profession. And I think, you know, leaving. And then among these 40%, there's top three reasons. Number one is work life balance. Number two, is culture. Number three is money. So by throwing money at people, you're really treating the symptom that is most prominent. So I think that we're trying to do the wrong thing, we're driving the cost up. And then therefore, we increasing the prices for the pet parents. And like all of this is a vicious cycle. So what we're trying to do, for two years, I've been designing the framework, and it's called consolidator operating framework. And it's not only lean, so I researched Lena was two years ago, but then I combined my knowledge from what's called safe. So it's a scaled agile framework. And this is for massive IT companies, at&t, Amazon went through transformation. So I got licensed in that, because I'm passionate about it and the software. But this is a methodology of Agile transformation of organizations. So we combine that with combined lean, we combined traction, which is entrepreneurial operating system, and we created a new framework in which you can build a consolidation from idea to basically a successful IPO, exit or just continuously grow an organization with a burnout prevention in mind, and to attract the veterinarian to work for this organization. And the next two months, it will be very interesting to see what's going to happen because we think that we found this sort of secret formula to transform the industry. And there will be some consolidators coming out that will be using this to the tee, and we'll see how that will impact.Stacey Cordivano:
Amazing. Well, I think that that is only going to be beneficial to veterinarians in the future. I appreciate all the work that you guys are doing. What are some ways that you could advise a veterinarian who is starting to feel burned out or struggling to figure out if their workplace is contributing to their burnout?Ivan Zak:
I heard this question a lot, and I'm not brave enough to say this is 123 you should be doing because I'm not that kind of doctor. No my patients bark and... But I do think that as you are feeling or thinking that you're feeling a burnout, you should seek for professional help. And number one thing is definitely not work more. The burnout is the feeling and some people confuse the two terms. There's compassion, fatigue, and then there's a burnout. So compassion fatigue is something that does go away on the weekend or on vacation. burnout is something that doesn't go away, go home, you go on vacation, it's with you, you're depressed, if negative thoughts and nothing makes you happy, that's it late late stage are something that needs to be addressed by professional and I needed professional help to help me with this. Because it can lead to very dark places. And I think the things To watch for in the environment, I can speak on the things that you want to consider if you're thinking your brain out whether those things are in your environment. So there's six classic triggers for burnout. And I think that with consolidation, they actually triggered more. So one of them is lack of control. If you don't have in your work environment, control over what you do, you're constantly micromanaged. And you don't have autonomy with what you do. They tell you what meds to use, they tell you to what prescribe how much this you should be doing in that, that's a trigger. So one of the things that you need to do is consider this is the right environment. The second one is value conflict, very, very important when these hospitals are going through acquisition. And if it's just a privately owned practice, when you're coming in, and a lot of privately owned practices don't even talk about core values, because we'll school that I build a clinic, we work in it, that's kind of it. So last six organizations that I've built, I started with determining core values, it's not hypothetical thing that you do, there's a methodology behind it. And we teach it, it's basically it comes from traction, you can read about it. So Traction by Gino Whitman, amazing, amazing methodology. But when you have core values, and you align the people that you hire, not because they can do stay in 10 minutes, and whatever that person is doing. But because your core values is aligning, you have the right person, a lot of people talk about that you're the right person who's the right person in the right place, it's not a player or whatever producer, it's our core values yours and mine align. And if they don't align doesn't mean that yours are not as good as mine, which is different. So we use it a lot of VIPs. And we teach that and we practice that we review our core values continuously, and we review each other on the core values do you fit with seven core values that VIS has. So the same thing in the organization, you continuously need to align. And what happens during acquisition, the company comes in with their core values. And they just say, Now, these are your core values, you don't change those overnight. So you really need to understand if you align if you don't leave, and sometimes the catches that the core values may sound one thing, but what purpose is different because of you know, its integrity and honesty and love for pets, but in the boardroom, it's a different conversation. That becomes apparent very quickly. We're a small industry. And then when you're saying we're going to improve lives of veterinarians, and that's our goal, but our goal is 100 clinics in 18 months, that's a different goal. So disconnect of core values is number two, insufficient reward, especially with technicians. So that's very important. And it's not only about money, I always say to everybody, thank you is free. So if you appreciate people for what they do continuously and underlying, and always do shoutouts, that's thank you for X and X for helping me with that. That is also a huge component, not just money, but even the money is also important. So if people are not rewarded for what they do, that's important work overload. And that's what everybody thinks burnout is he was working too much. They just wanted a fix and fairness. So again, with change of ownership, there's a lot of the times people were working towards ownership and being associated. And then they flipped a consolidator. And now there's unfairness. And then one really, really, really important is breakdown of the community. So training on feedback in the clinics were terrible, and that veterinarians are the lowest EQ out of all professions. And it's actually it's documented. So learning how to give and how to receive feedback is very important. So those are the six triggers. If you watch those, then if you see that some of those are kind of creeping in, then maybe it's not the right place for you.Stacey Cordivano:
Great. Yeah, that's great summary and great advice for people to keep an eye out for themselves. I ask all of my guests what is one small thing that has brought you joy this past week?Ivan Zak:
Joy past week... we're always doing the weekly meetings, everybody should say one business and one personal thing that were great last week. So I love but they do that. We do it in our leadership meetings. But joy, I think I did a series of little pictures and collage for my wife of our kids. And I put them up on the wall and it looks amazing. So that brought me joy and how she loved it.Stacey Cordivano:
Awesome. That's great. Yeah, I think finding the small joys is really important to stay happy when our jobs are difficult every day. So I love that one. That's a good one. Well, thank you so much for your time. I know you can be found a lot of places you co host two different podcasts. What are those podcasts so other people can check them out? Because I've listened to them both and they're awesome.Ivan Zak:
Thank you. So Veterinarian Innovation podcast. So once a week we talk to innovators in the industry. So that was pretty awesome. I co hosted with Sean Wilkie CEO of Talkatoo dictation software. I make fun of him by every show. And we give Starbucks cards for people that will help you do that. Then the second one is a little more nerdy and serious. It's about the consolidation. So it's called Consolidate That it's all about what we teach, consolidators and how to build organizations burn out proof.Stacey Cordivano:
Yeah. And I looked through it and I feel like for a veterinarian who is thinking about selling to a consolidator or corporate it would be actually pretty helpful for them, I think.Ivan Zak:
Well, thank you. And I will make sure to link all of these places in the show notes. But where else can people find you? where's the best place to reach out if someone has questions for you?Ivan Zak:
Our website vetintegrations.com has a lot of this information a lot on burnout, we publish a lot. We published about 15 articles per quarter. So definitely you can check it out there. And then if you can spell my last name Zakharenkov you can find me on LinkedIn.Stacey Cordivano:
Okay, I'll make sure to link it to thank you so much for your time and expertise and insight into the wild world of Veterinary Medicine. Thanks.Ivan Zak:
Thank you for having me.Stacey Cordivano:
Thanks again for listening today. I hope you enjoyed the show. If you did, please share with a friend and make sure to follow wherever you listen to podcasts. You can also subscribe to our newsletter to make sure you don't miss any tidbits or future episodes at the hole veterinarian comm slash subscribe. I'll make sure to link all of Dr. Zach's information in the show notes. So check that out if you'd like to get in touch with him further. I hope you have a great week and next month we are highlighting moms in vet med who are doing amazing things. So there will be a bunch of new episodes and make sure to keep your eye out for those. Talk to you soon.