Speaker 1 (00:01):

Welcome to practice. , where doctors and practice owners share business, lifestyle and marketing stories. All while, guiding you to more patients. Here's your host, Zach Greenfield field.

Zack Greenfield (00:16):

Hello everybody. My name is Zach Greenfield. Welcome to practicesOmatic. Today. We have Dr. Michelle RO with us and she is out in Pennsylvania. She's the locum rehabilitation veterinarian for the MBA group and she's at the press, Princeton animal hospital. So she's running up their rehab and there's actually three locations that she's floating around. So Michelle, go ahead and say, I'm so glad to have you here with us today. Hi, thanks for having me. This is really exciting. Yeah. So fun. We um, so Michelle and I talked a little bit before the show and, um, one of the things that's fascinating and unique about her story is, um, that she's been able to sort of bend her career and her workload to fit around her family's specific needs. So one of the things on the show Michelle that I love to do is figure out how sort of entrepreneurial vets like yourself, you know, navigate the complicated business environment. And what's interesting about your story is that you're not the owner of the practice, but you've managed to be an entrepreneur within the ecosystem. Um, that's out in your area. So tell, tell us more, a little bit about your role and how that evolved for you and your family.

Dr, Michelle Rupp (01:40):

Um, so really my, my career has taken on a lot of really interesting twists and turns. Um, so when I graduated from that school, I started in the pharmaceutical industry and, uh, I guess I had been out of school. Hmm. What was I out of school now eat about eight years? Um, when I got pregnant with my daughter and, um, as far as we knew everything was okay with Emily, but, um, she was born three weeks early and there were some complications at her birth and she was actually born with a pretty significant birth defect. Um, that sort of changed the course of my career. Um, so it was difficult to kind of stay in that pharmaceutical environment. And, um, I went back to private practice, which was also a series of challenges. Um, prior to leaving the pharmaceutical industry, I had started doing acupuncture and I did it in relationship to a particular project that I was working on in the pharmaceutical industry.

Dr, Michelle Rupp (02:44):

Um, and so when I got back to private practice, I was really looking for ways to kind of apply acupuncture to, um, you know, the day to day practice and really kind of utilize those skills that I had developed. And then, uh, with the birth of my daughter, we spent twice a week for years, just quite frankly, on end, um, in physical therapy and then eventually occupational and speech therapy. And so as I was spending all of that time and trying to figure out ways to support her, I started thinking about how, what we were doing for her was really relevant to some of the things I needed to do for some of my acupuncture patients. Um, so generally if I got referrals from local veterinarians, what they would send me where those sort of disaster patients that, you know, I think they thought I couldn't mess them up too badly because they really, nothing else had really worked for them.

Dr, Michelle Rupp (03:38):

So, uh, acupuncture was helping, but, uh, when I went on and got that training in rehabilitative medicine, and I found that I was able to add another little layer. So, you know, the patients that nobody thought would walk again, I was able to get them up and walking. Yeah, those geriatric patients that you know, were uncomfortable and medications just weren't quite enough. Um, I was able to keep them more comfortable and add a couple of years to their lives and, um, really became much more able to help my clients in a different way. And also, um, had the opportunity to develop different relationships, uh, with my clients. So over the years, I've done a lot of different things, sort of just kind of tried to do rehab on my own. Had always thought that I wanted to start my own veterinary practice, but, you know, because of the challenges with my daughter, I was reluctant to take that huge financial step to really step out

Dr, Michelle Rupp (04:38):

On my own. It was

Dr, Michelle Rupp (04:41):

Really scary and I didn't, I never knew what the future would hold for her. And I always kind of felt like our money wasn't really our own. Um, I felt like I needed to make sure that there was that good nest egg to take care of her if, and when something happened to us. So I, I struggled with that for a long time. So, um, what I ended up doing is I did some relief work. I ultimately, I worked part-time in private practice for a while. I did some, um, sort of practice management work in some of the practices that I worked in. And then I started doing relief, but as people started to realize that I did acupuncture and rehab, they thought it was kind of interesting. And so I worked several places doing a little bit of rehab here and there and, uh, let's see, in 2018, um, I got a job as Mount at Mount Laurel animal hospital, as the department head for rehab, really kind of leading up a relatively new service at their particular practice. They had purchased an existing rehab practice and they were beginning to transition it into their hospital, um, which was, uh, you know, full service, emergency general medicine, specialty practice. Um, and then COVID came along and, uh, our entire department was shut down. We were all laid off and

Zack Greenfield (06:04):

Yeah, excellent. The pandemic, which I mentioned you before chatting, I've had conversations since last year that are everywhere on the scale with, with veterinary practices from the pandemic, caused them to boom and being super busy as people were holding potentially their animals or something to exactly the story you're telling, which is closures and layoffs or furloughs.

Dr, Michelle Rupp (06:34):

Yeah. And you know, the interesting thing is I think that rehab would have really had the opportunity to boom, but I know in particular, in my area, we were told that we weren't allowed to do anything that was considered non-essential. So, you know, really you were led to believe that the only thing you could do was emergency medicine now, so is, is rehab emergency, I guess it depends on your perspective. Right. You know, I have some clients that had geriatric patients that were doing really well coming into the pandemic and then all of a sudden four or five weeks in, they're not moving so well anymore. Um, and, and in some of these older guys that kind of became an emergency for clients. So to be perfectly honest, I certainly feel, I struggled difficult for me too, because, you know, I struggled, I knew what these patients needed and I, you know, and I, I, I was trying to look at it from the perspective of, you know, what public health service was telling us and really thinking about this

Zack Greenfield (07:39):

Confusing messaging

Dr, Michelle Rupp (07:41):

For everybody. Yeah. Yeah. And so, you know, I have had this kind of hobby practice for a number of years when I started in the pharmaceutical industry a few years in, I started doing some behavioral medicine and then I bought a mobile clinic and I did, I traveled a little bit, did some vaccines and some in-home euthanasia and things like that. So I never really let my hobby practice go. And I have permission from my township to see a few patients in my house. And so I had an old website that I really haven't done anything with. And so funny enough, some of my clients that I had seen at other places started to find me, you know, they kind of joke that they kind of cyber stalked me and they started calling me. So a few patients that really needed treatment, you know, I saw them and did some creative things to kind of get back in the swing of things and to keep those patients going for a little while,

Zack Greenfield (08:37):

It's a Testament to anybody that's listening. That's, that's in an employment situation where, you know, this is the illusion of having a job when you experienced it, is that, you know, they teach us in school, like getting a job means you're safe. That's not always the case, you know, being in charge of your own destiny and control what's going on is the safest place to be. And thankfully you did have that old website and a few things out where people can find you and track you down. It just goes to show that even if you're employed and you know, you as a doctor, you know, human or animal doctor these days, you really want to maintain some of your own real estate online so that if things change, um, you still have, you know, your name out there and the people that are your fans and your patients can, can find you when they need it.

Dr, Michelle Rupp (09:34):

Thank God for that. Right. Yeah. Well, I don't, I don't know if it was necessarily luck to be perfectly honest with you early in my career. I had some experiences at work that were less than enjoyable and, you know, I was fresh out of school. I wasn't married at the time. I didn't have another source of income and I was making good money and it was not a place that I enjoyed. I mean, I remember waking up and crying for half an hour before I would go to work every day of the week. Right. And so I made that conscious decision when I left that job, I was always going to have a backup plan. I was never going to feel trapped.

Zack Greenfield (10:13):

Okay. So it wasn't dumb luck. It was kinda, you were always feeling like you were running a little bit of an insurance policy in the background. I think that's awesome. And I think that's something that everybody should do. It's unfortunate that you did it out of, you know, a negative experience, but despite whatever that is, it worked for you in the end.

Dr, Michelle Rupp (10:34):

It did that. It did. And, and I think, you know, learning to really network is important too, because that's how I ended up where I am today. So, you know, I got, so I got laid off, uh, what a year ago, March. And, um, it was okay because, um, you know, my daughter, she's doing well in school, but she needs lots of supports and going virtual didn't give her access to the kinds of supports that she needed. So the end of the school last year, I kind of stepped up and became her teacher. So it would've been really difficult for me to work. Um, so it was a challenge. Yeah. I can imagine. Um, and Emily needs more support and you know, I'm not, you know, I always say that the role of the veterinarian is educating. I mean, we educate our clients on all kinds of things, but, uh, it's really hard to be your kid's teacher, especially when your kid has disabilities, no matter how well you understand them, it's hard and I'm not always the most patient person. So it, it, I needed that time to try and figure things out for her. And so then, you know, I debated, what do I do over the summer? Do I really go out there and try to find another job? And again, there was a lot of mixed messaging, two weeks to slow the curve, and then two weeks became months.

Zack Greenfield (11:54):

I didn't even know. It's hard to tell if you were allowed to go out of the house or what the deal was.

Dr, Michelle Rupp (12:00):

And so, um, I, you know, I, I kept feelers out there and I was constantly getting calls about, you know, going out for relief work and interviewing for jobs. And I, I interviewed and I had been working part-time at a friend's practice and she had offered me a full-time job and nothing felt right. I just, I needed to take some time and really step back and really think about what I wanted. Um, and so the pandemic gave me the opportunity to do that. So I probably had three or four job offers that, honestly, I turned down not really knowing if I was going to find another job, but I felt like the right answer was out there. Um,

Zack Greenfield (12:41):

No, it's a nice that you're like you had enough, you know, sort of grounding covered, right. That you're okay to just pause and not feel like, you know, you got to desperately make a decision that you might regret and under a lot of circumstances that we were all very uncertain with. So that's awesome that you just kind of had that Cheree to trust in the universe, I guess, if you will.

Dr, Michelle Rupp (13:07):

And I mean, it helps that, you know, my husband has a good job and, you know, and he has the medical benefits and all those kinds of things. So I didn't, you know, the money that I make allows us to have a different life. Um, and so we could survive on his income, but we can do other things that we want to do because of my income. So, uh, since we weren't going anywhere, you know, I wasn't spending as much money. So it was a little easier right. Grocery store. I know, I know. So, so that gave me the opportunity just to kind of hang back and really think about what I wanted. And so I was just catching up with a friend. I had worked with a few years earlier and we hadn't talked in a while and of course, you know, like many people, it was a time to reconnect.

Dr, Michelle Rupp (13:55):

And so I reached out to my friend and, uh, she had been working for NVA. She had worked for them for, I think about two years by that point. And she really liked the practice. She was in Lancaster, which is, you know, for me, probably a good hour and a half drive. Um, and she wanted me to come work for her and do rehab out there. It's just, it was with traffic. It can be as much as two hours, um, to get back from there. So it was a little further than I wanted to drive, but I, I considered it. Um, and so we, you know, we were just kind of having a casual conversation and she said, well, the company had been looking for, um, the relief doctor or two that they would, you know, keep on retainer just to kind of fill in whenever they needed somebody.

Dr, Michelle Rupp (14:39):

And she asked if I was interested and I said, sure, you know, I don't close doors anymore. You know, I kind of explore everything and see where it goes. And, um, so you know, she out to her next level management and, uh, they said that they were okay in terms of relief doctors, but they were really intrigued by the fact that I did rehab and they wanted to know if I was willing to travel and the rest is history. Um, I said, so here I am. So now I traveled to, uh, let's see, I mean, for, um, hospitals currently for NVA. Um, and I am actually just talking about adding the fifth hospital, um, which is actually, it's an emergency clinic. NVA has, um, purchased, or they've merged with a group called compassion first, which has emergency and specialty hospitals. So, uh, we're kind of looking at maybe me helping out at least one of those hospitals right now and getting rehab up and running for them. Um, and then I've been approached about another, um, kind of a startup organization that I can't really talk a whole lot about right now. I've signed a non-disclosure, but, um,

Zack Greenfield (15:56):

Uh, yeah, yeah.

Dr, Michelle Rupp (15:58):

So that's something new too, that I'm having some conversations about helping to start up a rehab program for them. So, um, things have really kind of, you know, out of something as traumatic as the pandemic, things are kind of headed career wise, the direction I've wanted them to go. Um,

Zack Greenfield (16:16):

I think that, I think the thing that's fascinating for me, you know, is that you're living proof that, you know, job and sort of an entrepreneurial approach to your life are not necessarily mutually exclusive. You've actually one of the few folks I've talked to that has kind of pulled it all off on both sides of the fence. You know, it's like, you've got the security of, you know, a bigger company that's interested in your services in there and you didn't have to take a bunch of, you know, scary financial risk to continue to follow your passion and sort of set your own terms with this. I mean, you're okay. Moving around and, and seeing patients at different hospitals and, and then you kind of carved out this, you know, area of practice in rehab within their group. That sounds to me like you're sort of developing for them. So that's, that's amazing. Yeah.

Dr, Michelle Rupp (17:15):

Yeah. It's exciting. I'm not quite sure how I ended up here, but I'm grateful that I'm here so

Zack Greenfield (17:20):

Well, I mean, you know, from listening to you and it just, it sounds like part of it was your, you know, degree of patience trying to push so hard, you know, that's one thing I think when you get a little bit older, like, you know, and I, uh, when you realize that, you know, your time is actually on your side, I think when you're younger, I mean, I certainly was like panicked about timing, kind of in a rush to achieve all these things. And you get a little bit of maturity under your belt, and then you realize that, you know, stuff kind of tends to work itself out in the best way, if you don't, you know, force, feed things too hard. So I think that's a big part of it is like you displayed an incredible amount of patience during this last year and to see how things were going to kind of unwind and then it all sort of just became perfect for you and for your time with your daughter and, and your overall goal. Right. Because one of the other things that, that Michelle didn't tell me about, uh, before we got on this recording was, you know, she actually has almost all, what did you say? Like basically all the equipment and everything almost opened a practice. I do.

Dr, Michelle Rupp (18:31):

Yeah. I've been slowly over time. I've been buying and adding and now everything I have is probably outdated, but my rehab equipment is all relevant,

Zack Greenfield (18:39):

So sure. Yeah. But like, it's, I love your story because it's like, you kept marching towards this kind of like, you know, I'm doing my own business thing. And then, um, it's part of the reason why I think that, you know, you are the attractive candidate to run up this, this, you know, multi location effort for this bigger group, you know, because it's like, if you think about it from their perspective, in order for them to launch this, they need somebody that's a, self-starter like you are right. And until the thing is, you know, systematic, then they can plug in more of the, you know, sort of employee minded folks, but you kind of got, like I said, it's just this, this, this, this amazing story. And I think that even, you know, the highlight of it is that you always kept it in balance with the needs of your, your family and your daughter, which is, you know, it's tough to do.

Dr, Michelle Rupp (19:44):

It's hard. And, you know, there are a lot of days that I feel like it, everything is really out of balance. And, uh, you know, I don't know, my family may say that it's not always balanced real well, but, um, but I try and I think the other really important thing is that, uh, we've always set high expectations for our daughter. And, uh, I've tried really hard to be a good role model for her. Uh, for a lot of years, I really kind of stepped back from my career and she's made a lot of progress. She's doing things we were told she'd never be able to do. And now I've said to her, it's your turn to start stepping up and taking some responsibility for yourself and your actions. And now it's time for me to take my career back. Um,

Zack Greenfield (20:28):

And so that's, yeah, I mean, it's very time spent. I mean, kids are only going through whatever their developmental arc is, you know, late accelerated as a matter that there's only a limited amount of time for that. Right. And as parents, you know, you either decide you're going to be there for that chunk, that chapter, you know, be fair to the present, um, or you're gonna miss a lot of it. Right. You know, and, and, and the other stuff, you know, all this work stuff and everything is kind of always there right now with the kid thing is like this limited opportunity that you have. Um, I dunno. I mean, I, I'm always looking back at my, my, uh, my daughter's 15, my son is 11 and they like, they're in a, you know, that time where they're sort of like stepping away, you know, turning into teenagers and all that. And, um, but you know, same just like you that's allowed me to focus more on work and nobody feels like we're making, you know, nobody feels bad about it at this point because they're starting to live their own, you know, sort of governmental alive, I guess it'd be willing to keep team life, whatever that is. Right. Which

Dr, Michelle Rupp (21:39):

Is scary. My daughter is 16 now. So I'm seeing all of that too.

Zack Greenfield (21:44):

Yeah. But it's, but it's like, that's the challenge, I think with, you know, any professional career and more than anything, one that you're passionate about, you know, you love working with the animals and, and doing rehab and, and seeing what you can do with maybe a patient that, you know, another doctor would look at and kind of abandoned where you see, you know, opportunity because you have a different perspective on it, you know? Um, I don't, I just, I just think that it's cool. So, so tell us, you know, Michelle, like, what's next, now that we're kind of coming out of the pandemic, you kind of got this, you got this thing that's sort of taking shape. Like what, where's the next 12 to 18 months? What do you think it looks like?

Dr, Michelle Rupp (22:30):

Well, I mean, ideally, um, we're going to grow and expand rehab at all of these sites. Um, we've just hired a traveling technician who is now traveling with me. Um, yeah. Uh, we, yeah, we are, um, some of the challenge initially was that, um, the hospitals that I traveled to, they were short-staffed because, you know, like every other business, um, sometimes people are scared to go to work or they're making more money, um, to be home on unemployment right now. And it's just, it's hard to staff every business. So the veterinary industry is experiencing some of those same things. Um, so a lot of the practices were short-staffed. So for me to come in and try to, um, you know, restrain a dog and put acupuncture needles in and do all the other things that I do doesn't work very well, especially since we're curbside, right.

Dr, Michelle Rupp (23:28):

I don't have clients in there with me as well. Um, so, so I needed help. And so, you know, some of the hospitals in terms of the amount of time that we were able to dedicate to rehab and w you know, when we thought about trying to market this suite, we really kind of had sometimes have compressed hours because they didn't necessarily have staff when I was available or, or maybe they were busy with their own patients and just didn't have the space. So we had to kind of think about it a little bit. So adding this, um, traveling technician, uh, gives me somebody that, you know, really I can kind of train to the way I do things and, um, allows me to, you know, be a little bit more efficient over time. It's going to take, she just started with me. But, um, yeah.

Dr, Michelle Rupp (24:14):

So I think that will give us the opportunity to become a little more efficient at some of these other sites. Um, Princeton we're, we've been pretty busy at Princeton, but I started there in September. So, uh, the other sites are relatively new. Um, and there was a small existing rehab client-based Sierra. The, the prior owner of the practice had done some acupuncture and a little bit of rehab. Um, so that gave me a little bit of a leg up there, but my goal is to make Princeton, uh, really potentially full-time for me, I would like for it to be, you know, four, 10 hour days, five days a week, maybe more, uh, and, um, I would like to get busy enough to add some more nurses there. And then I would like to expand the offerings at these other hospitals. Um, so, you know, so she

Zack Greenfield (25:03):

Sends me kind of the model.

Dr, Michelle Rupp (25:06):

Yeah, that's kind of, my goal is to really model everything at Princeton and then eventually, you know, kind of build protocols and build the service at these other hospitals and start hiring rehab doctors and really, um, kind of training them to how we do things. A lot of rehab practices are, you know, laser and underwater treadmill. And so an underwater treadmill, isn't all that portable. So I don't have underwater treadmill everywhere. So I, I do a lot of other things. We do therapeutic ultrasound and muscle stem and acupuncture, and, you know, I find little creative things. I read a journal article here or there, I see something that they're using in humans, or I think about things that we've done for my daughter. And so I do a lot

Zack Greenfield (25:50):

Of kind of immersed in it to science or your personal side, professional side of sauce.

Dr, Michelle Rupp (25:56):

Yeah. Yeah. So that's kind of, my goal is to really start to train, um, rehab doctors, how to be a little more out of the box and also start to think about how do we make the, the rehab practice efficient so that it can sustain itself. I mean, you need to make some profit on this, right. Otherwise it's not a viable business. That's

Zack Greenfield (26:20):

Part of the business needs to feed me, it'd be there. So that the next animal, that services, you know, it does exist. Tell, so tell me just a little bit, just to circle back. So you, you're still a curbside check-in, so that means the person pulling up to the practice in the car, a technician or assistant or somebody who's coming out to retrieve the animal.

Dr, Michelle Rupp (26:46):

Yeah. So, um, for the most part, the hospitals that I'm traveling to are doing general medicine with clients in the hospital. Um, but in terms of rehab, especially at Princeton, we're, we're double booking I'm most of the time seeing anywhere between 10 and 14 patients a day there. Um, and so I have an exam room and I usually have two dogs and at least two nurses and myself in a room. So it doesn't really leave any room at all for a client to come in, regardless of whether we, you know, even think about social distancing, there's just not room. Um, and we have tried, um, we have tried like zoom, you know, sort of telemedicine with the client curbside at some of the other practices, but the technology hangs up or the clients have difficulty connecting. Sometimes we have older clients that aren't as savvy with their phones, smartphones and things.

Dr, Michelle Rupp (27:45):

And so you spend the first 20 minutes of your session playing with the technology. And so that's kind of frustrating. So we haven't really used that a whole lot. And to be perfectly honest, I think that rehab works when the clients are there or when the clients are able to have conversation with you. So this is where rehab for me is really inefficient, um, because I will usually go out, um, speak to the owner. I, I try to talk to them when they, when they bring the pet initially, but sometimes I'm in the middle of placing act, especially at Princeton where I'm doing two patients at a time. Sometimes I'm in the middle of placing acupuncture needles when my next patient comes in. So my nurses there have worked real hard to make us efficient. They've done a great job there. So a lot of times they'll go out, they'll take the history, um, you know, kind of chat with the owner a little bit, especially those, those patients that we've seen before and they're coming back for their follow-up visits.

Dr, Michelle Rupp (28:41):

And then, you know, they'll always say, is there anything in particular you want the doctor to know? You know, and she'll, she'll come out and talk to you at the end of the session. So I try to have at least one direct point of contact with the owners during that rehab session. If it's not a real busy day, then I might go out when they, you know, bring the pet initially. And then also when we bring the pet back to them, um, but I try to have at least one point of contact so that they can get all of their questions answered. And I really prefer that face-to-face contact, like, I think so much is lost on the phone. Um,

Zack Greenfield (29:14):

I think, I think it is, it's just, I'm interested in, um, I'm listening to your perspective on it. And again, this is, you know, I'm in this kind of privileged spot, or I talk to so many doctors every week, you know, my clients and folks like you, then I'm just learning and hearing stories from, and, and, um, there's so many different opinions on curbside and telemedicine and, you know, then, you know, the idea that they're sort of being used together. So, you know, it's another kind of came out of this last year and, you know, I think for therapy, you know, a big part of an animal's rehab is how they're doing at home. Right. So that you really, the more interaction you can have with the owner, the more on the day to day, when not to see you maybe once a week or something, cause there's a lot more time at home and you know, there's a whole protocol for that, right?

Dr, Michelle Rupp (30:26):

Yeah. You know, so some of my patients we're sending home with exercises, some of them, um, you know, we don't, you know, maybe the clients are too busy or, you know, whatever, they've got kids at home, they don't, they can't do it. Or, you know, they're older maybe, and they can't do the exercises with the dogs. But when I'm trying to show a client how to do some of the exercises that, um, you know, I may prescribe, uh, it's hard to do. It's really hard to do over zoom. Um, there's so much that's lost in that. And then you go out in the parking lot. Now you're trying to keep the dog from, you know, running away, running into the street. The dogs are interested in everything that's going on. It's just it's no, no, it's just so, um, I'll be glad when everything is cleared up and, you know, everybody's able to come back inside again.

Zack Greenfield (31:17):

Got it. And so do you feel like, I mean, I just, it's just an opinion question. Do you feel like your sort of specific area practices, it's just where the real rub is or telemedicine or, I mean, or do you think in general it's just more to learn, but that, about where it can be applied appropriately versus where?

Dr, Michelle Rupp (31:42):

Yeah, so I think for me personally, um, I don't like telemedicine really much at all. I think it's okay. Maybe the answer some general questions, but in terms of really being able to assess a patient, I, I don't like it. I mean, I have had some experiences myself with some health issues over the last year and, um, you know, where I use telemedicine and I, I, I didn't like it. I didn't think it was useful. I think it probably delayed me, um, getting some answers and some things that I was looking for some questions I'm asking. Um, and I, I mean, I'm not doing general medicine much anymore, but I don't know that I would be terribly comfortable trying to make a diagnosis with telemedicine in veterinary

Zack Greenfield (32:32):

Medicine. I think it's extra tricky. Cause you know, the interesting thing for all veterinary doctors like yourself is that, you know, you're dealing with a patient that can't really tell you anything beyond what their body languages and, you know, the exam results and stuff that they can't verbalize, you know, pain or discomfort or any of these things. You know, you guys sort of have to sleuth all that out through, through your experience and all of that schooling and everything. So when you bring in telemedicine into it, to me, it almost looks like you're adding in like another, you know, like the telephone game, you know, where the message gets worse as you keep going. Since I can go in from the animal to the owner, the owner is trying to explain that over video call, which is already got, you know, some kind of, you know, issues to that. And then, and then you're trying to make an interpretation. It's just hard because you're so, so many steps away from the actual patient that you're trying to, you know, work in human practices. No, it's not, it doesn't introduce like there isn't that extra step, you know, communication because a perk, you know, obviously a person can say, you know, what's going on to somebody. Right. So I think, I think you're right. I think for veterinary medicine, is it presents a unique set of challenges because the patients don't talk. Right.

Dr, Michelle Rupp (33:59):

Right. Well, yeah. And I think, especially for me trying to do rehab, you know, maybe if the camera angle is right and maybe I can see some subtle lamenesses by watching some video. Um, but your angle has to be right. Your, you know, the camera has to be study. If it's jumping around, I can't necessarily see those subtle lamenesses, but even more challenging. I have clients tell me all the time that, you know, their pets are not painful, but not every dog screams when you touch something that hurts. I've had lots of patients that I palpated and the dog just gets really stiff when you get to something that hurts or they don't react, but you'll feel a muscle spasm when you poke something that's painful and the clients aren't going to know

Zack Greenfield (34:41):

That yeah, the dog, the breed I've had several animals and, you know, like, uh, I had a bit, I had a big route Weiler years ago and he's since passed, but he there's nothing to hurt that dog. Yeah. I mean he never expressed pain. I mean, he can probably, you know, he'd be running around with like a broken leg and he'd just keep going. Um, and then, you know, we had some smaller dogs, different breeds, you know, anything, I think in a, like a little cactus mingle on their foot or yelping and hopping around like, you know, full blown trunk. So you just amplitude, you know, what that can be is just all over the scale for, you can only imagine. Yeah. There's a lot, there's a lot. So I, yeah, I think, I think that, I think the jury's still out on telemedicine. I think this year you may be every professional really had to explore the sort of deep end of the video chat, swimming pool in general. You know, we all had to dive in because there wasn't a lot of, um, alternatives if you wanted to try to get anything done, but, um, you know, um, cautiously optimistic things or I don't know how, how are things going in Pennsylvania right now? Does it feel like it's getting better? What's going on out there, you're on the ground, you're working it's happening.

Dr, Michelle Rupp (36:09):

Um, so the, you know, the mask mandates are supposed to be lifted, I think, um, this week, next week, something like that. Um, so, you know, I don't know. We'll see. I mean, I know that I've been exposed to COVID. I was working with a coworker who tested positive and she was vaccinated, um, and tested positive. And I think there were three of us. Um, none of us got sick, none of us tested positive, so I'm not, I don't know. I just go to work and I do my job and I'm not worried about it. You know, there are risks in life, so

Zack Greenfield (36:44):

Yeah. But from a business standpoint, is the, is the practice still being run very conservatively in that regard?

Dr, Michelle Rupp (36:54):

Um, well, let's see. I mean, different practices and they all operate slightly differently. So yes, I think some of them are more conservative than others. Um, I was, for a while, I was working at a friend's practice doing a little bit of general medicine, uh, up until maybe two months ago. Um, and she'd been letting clients in, uh, and the practice was getting busier and busier every day she started, I think like last August or September letting clients in, um, and, uh, you know, they were masking and cleaning and all those kinds of things, but, um, they were starting to move back to normal last fall. Um, and then there are some practices that, you know, are slower at doing

Zack Greenfield (37:38):

That. Interesting. Everybody kind of has their own take on, you know, the folks that we work with here. I think by and large, everybody's in a hybrid sort of middle place. There's some that are letting patients that don't want to come into curbside and they're letting patients that want to come, you know, I mean, clients that want to bring in their animals, the, you know, they're saying, okay, we're okay with that. But uh, most of them have a one, one person in attendance rule. We try to limit the body count. So,

Dr, Michelle Rupp (38:16):

Yep. Yeah. That's what, uh, so, so Princeton, that's what they're doing. It's one person, they have to be masked if people want to be curbside for general medicine. Anyway, if people want to remain curbside, of course they can still do that if they want to come in, it's one person. Um, there's another practice that I'm at that they're still not really letting clients in too much. Um, but yeah, so there's, there's kind of a spectrum here.

Zack Greenfield (38:46):

Yeah. Yeah. It's just, it's just, we're still as much as everybody wants to feel like, you know, we're back at normal, maybe go to work every day. Thanks for just not right where they should be a hundred percent at all. And it's just struggling.

Dr, Michelle Rupp (39:01):

Yeah. I mean, I, I do think when I talked to my colleagues that are doing general medicine, it sounds like a lot of the general medicine in the emergency medicine practices are, are busy, like busier than they were before. COVID. Um, so I think probably from a business perspective, it's good, but I kind of wonder about the physical and emotional toll it's taking on everybody.

Zack Greenfield (39:25):

Um, yeah, I think I would, I think it's been just a hard year for everybody, you know, probably in the world. And certainly the folks that I personally know, I, um, you know, I don't think anybody had, you know, easy breezy here, but you know, it's like, yeah, the spectrum has been a lot of time. I've got a friend of mine, who's got a cleaning company. He's had the best year, but with that came all the other struggles, which is couldn't get employees, you know, had to work every weekend, you know, missed basically a year with his kids because the phone was ringing I'll stop. And everybody, you know, like businesses like venture off Susan and offices where they had like all these extra sensitization, because like, he wasn't felt like he was in a position to say no to all of that. So it just took his whole life away basically.

Zack Greenfield (40:22):

And then, and then the other side of the table is, you know, people that just everything shut down and they were whole sitting on their heads wondering what was next and everybody in between everybody in between. So Michelle I'm, I'm just thrilled. I think, you know, just to circle back, I think like the fascinating part about all of this is you're, again, this you're carving out this sort of entrepreneurial, you know, mindset without taking on what was an inappropriate amount of risk for your family. It's such a huge success story. And I think something that should inspire a lot of younger folks that are just starting there to think about if they want to have their own practice or, you know, or how they want to map their career. And I think, you know, what would you say to somebody who's coming out of med school right now?

Dr, Michelle Rupp (41:29):

Wow. Um, I would say I don't envy them. Um, well only because you know, the cost of that education just continues to go up. Um, and I think personally, yeah, personally, I think that's, for me, that's really scary. Um, but I think also, you know, probably words of wisdom, um, is just kind of when a door opens, walk through it. Um, and it sounds really silly and really crazy, but I am nowhere near where I thought I was going to be when I graduated from vet school, my career has not taken the path that I thought it would or the path that I intended for it to take. Um, and that's not a bad thing. Um, I think, um, yeah, I was gonna say, I, you know, I'm, I'm pretty happy with things the way they are. Uh, you know, I've hit some points in my career where I seriously talked about, uh, leaving the profession completely. Um, and you know, here I am, 24 years later, I'm still here and I'm doing things really differently, um, differently than I ever thought I would. And probably, you know, quite different from what a lot of veterinarians do. But, um, it works for my clients. It works for me and it works for my family. So that's, what's important.

Zack Greenfield (42:49):

Right? You got to check the Baptists and you know, a lot of times the other thing for, for folks that have done this many years you have is sometimes the difference between success and what feels like a moment of failure or something like that. It's really just time.

Dr, Michelle Rupp (43:10):

Yeah. I agree. Just

Zack Greenfield (43:12):

Takes time to get to the place where you're finally are comfortable and things are in balance. So the money is right here, the lifestyle is right. And that your job is still as fulfilling as you originally had to hope the school.

Dr, Michelle Rupp (43:25):

Yeah. And I think it's not just time. I think it's perspective to be perfectly honest with you, you know, because I don't have that, those, those boxes that I thought I needed to check great, that, that big successful practice that's generating, you know, 10, $15 million a year or whatever, you know, this huge practice that I'm going to sell to some big corporation. I don't have that. Um, and, but I also don't have all the responsibility that goes along with that. Right. And so if I, if I sort of look at where my career is right now, it's not that traditional like success story, right. That you'd think of. I don't, I don't check all of those boxes, but what I've come to realize over time is I don't necessarily need all those boxes either.

Zack Greenfield (44:08):

Well, your story is a story of real success, not the success that is mine. You know, what they selling you at school against you in the role. That's true. That's a legitimate thing. I want to hang on to that story because it supports their agenda students and getting tuition, money and stuff. But that, you know, that's not the one version of what success looks like. And that's why I do the show thrill came on and shared your story because your story is a story of success. And it doesn't sound like anything that talks about school, which is amazing. So thank you so much. I really appreciate your time. And, uh, and, uh, you know, if anybody's in your area there and the, in Pennsylvania and looking for rehab and as an animal that, uh, that needs that kind of care, then you're of course there. Thank you so much. Right. Thank you.

Speaker 1 (45:20):

Thank you for listening to this episode of practice. So subscribe to the podcast. So you don't miss any future episodes for additional help and resources for your practice. Visit Zack greenfields.com to connect with Zach. Visit Zach greenfield.com/zg.