The Path to Owning It
30. Ready to expand? How to grow your veterinary hospital into multiple locations, with Mike Robinson, VMD
With Dr. Mike Robinson
Building relationships with patients can be one of the most rewarding parts of owning a healthcare practice. (Or, for veterinarians, also building relationships with the patients' owners.)
What happens when you decide you want to expand your practice into multiple locations? Will you still have the time to dedicate to connecting with patients? How will you foster the kind of culture you want in your new locations?
Meet our guest
Dr. Mike Robinson, VMD has learned the answers to these questions and more on his road to becoming the owner of multiple animal hospitals in North Carolina.
He began working as an associate at Cabarrus animal hospital in North Carolina in 2011, and a few short years later, he found himself in a position to purchase the hospital. Then in 2019, he opened a startup clinic in Harrisburg and in 2022 bought a third clinic in the same area. He’s currently in the process of completing a ground-up construction project which will be the future home of both Harrisburg hospitals.
In this episode
- How to know when it's time to open a second location?
- What challenges can doctors expect when deciding to expand?
- How is managing multiple hospitals different from managing just one?
- How do you maintain a company culture across multiple locations?
- How to structure your workforce to thrive in different locations?
Episode transcript
A lot of vets get into it because they love working with people and the animals. And the reality of going into a second practice is you probably can’t do both excellent. You need to have a partner who’s willing to do that side of it, or do you hire a manager who’s willing to do that side of it?
Welcome to The Path to Owning It podcast by Provide, hosted by me, Corey Brown, a marketing leader at Provide with over a decade in the healthcare industry.
If you’ve found us, you're likely an aspiring or established healthcare practice owner looking for tools and advice to begin your journey or take your practice to new heights.
And you’re not alone. So to help you achieve your practice ownership dreams, twice monthly, we’ll tap into our unparalleled network of industry experts… who will join us on our quest to provide the answers to your most pressing questions.
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Ever wonder what it’s like to go from being an associate, to hospital owner, to owning multiple locations? Today, we are joined by Dr. Mike Robinson who is going to tell us all about it! Mike graduated from the University of Pennsylvania’s Veterinary Medicine program and began working as an associate at Cabarrus animal hospital in North Carolina in 2011. A few short years later, he found himself in the position to purchase the hospital. In 2019 he opened a startup clinic in Harrisburg and in 2022 bought a third clinic in the same area. He’s currently in the process of completing a ground-up construction project which will be the future home of both Harrisburg hospitals. He is passionate about providing progressive veterinary medicine while providing an unparalleled customer experience. Cabarrus and Harrisburg Animal Hospitals pride themselves on creating a positive, family-forward work culture with the goal of exceeding the expectations of all pet owners they encounter.
Mike, it's so nice to meet you. Thank you so much for joining us. We're happy to have you on the show today.
Yeah, thanks for having me, Corey.
You know, I've heard a lot about you. I've gone to my team asking for veterinarians that they think would be great candidates for the show and your name came up first from a couple different people. And I know that you've had kind of a really interesting road to become the veterinarian you are today. So do you just mind sharing a little bit of your story with us?
Yeah, being a veterinarian was actually never on my radar. I wasn't the kid who kind of grew up thinking I was always gonna be a veterinarian. I had plans of becoming a human physician. My dad was a human pathologist. I was in undergrad, I had gotten kind of my first dog. It was a German Shepherd, it was six month old and got run over actually in my own driveway, rushed him to the emergency clinic and thankfully, you know, he survived the incident, but he was completely blinded. I lost one of his eyes and I was back and forth between the day clinic, which actually ended up being Cabarrus Animal Hospital where I am today, and the local emergency clinic. And it was really just kind of the first time I'd experienced veterinary medicine on that level. To me, veterinary medicine prior to that was vaccines and you go in and get some heartworm prevention.
You know, the idea of removing eyes and doing surgery and critical cases was all very new to me. So I was back and forth for about a week and became pretty good friends with the veterinarian that was seeing him at that time. And he just kind of said, you ever thought about being a veterinarian? And I said, well, no. He said, well, my dad was a human physician as well. He's like, why don't you just come check it out and work with us for the summer? So I did, I went and worked in the kennels was my first job at the clinic and just really found a different perspective on veterinary medicine. I remember sitting there studying for the MCAT and the six month old dog completely blind had just lost an eye. I'm miserable. People are saying, well, do you put the dog down? You know, what do you do? What kind of quality of life is that going to be?
And this dog is jumping and bouncing around and could not have been more happy and less concerned with what had just happened to him. And it just kind of showed me, like, if that was me, I'd be feeling miserable and sorry for myself. And here's this dog who is like nothing ever happened and ready to move on. And it gave me a new perspective on animals, let alone the industry. And so from that point on, I was like, OK, I think this might be my calling. And so from there I had to go back and start taking some classes in order to get into veterinary school, do some things to kind of set myself apart from all the people who grew up always wanting to be a veterinarian.
And so I went and trained dogs in Texas for a while and went and did some veterinary trips in Costa Rica and Nicaragua and then ultimately ended up getting into veterinary school at the University of Pennsylvania. From there I went on and did an internship at veterinary specialty hospital in Cary and then came back to Cabarrus Animal Hospital where I'd taken my dog from the very beginning, started working there as an associate and a couple years later I had the opportunity to buy the practice with a partner.
You know, the idea of removing eyes and doing surgery and critical cases was all very new to me. So I was back and forth for about a week and became pretty good friends with the veterinarian that was seeing him at that time. And he just kind of said, you ever thought about being a veterinarian? And I said, well, no. He said, well, my dad was a human physician as well. He's like, why don't you just come check it out and work with us for the summer? So I did, I went and worked in the kennels was my first job at the clinic and just really found a different perspective on veterinary medicine. I remember sitting there studying for the MCAT and the six month old dog completely blind had just lost an eye. I'm miserable. People are saying, well, do you put the dog down? You know, what do you do? What kind of quality of life is that going to be?
And this dog is jumping and bouncing around and could not have been more happy and less concerned with what had just happened to him. And it just kind of showed me, like, if that was me, I'd be feeling miserable and sorry for myself. And here's this dog who is like nothing ever happened and ready to move on. And it gave me a new perspective on animals, let alone the industry. And so from that point on, I was like, OK, I think this might be my calling. And so from there I had to go back and start taking some classes in order to get into veterinary school, do some things to kind of set myself apart from all the people who grew up always wanting to be a veterinarian.
And so I went and trained dogs in Texas for a while and went and did some veterinary trips in Costa Rica and Nicaragua and then ultimately ended up getting into veterinary school at the University of Pennsylvania. From there I went on and did an internship at veterinary specialty hospital in Cary and then came back to Cabarrus Animal Hospital where I'd taken my dog from the very beginning, started working there as an associate and a couple years later I had the opportunity to buy the practice with a partner.
That's an amazing story. How did you go from, being associate to deciding that you wanted to become an owner? What did that thought process feel like?
Yeah, so my undergrad degree was in Spanish with a focus in kind of an international business. So business had always been something that I thought, okay, I have an interest for that, I have a passion for that. My father, like I said, was a human pathologist, but he also was a part owner in a ClinPath lab. And so I knew that he had employees. I saw how things went with him at work. And so I always kind of was drawn to the idea of, okay, I can be a physician, but I can also potentially be a veterinary hospital owner in this case. And so when I got to the practice, it was more of an old school practice and business wasn't really, you know, on the front of their minds. And, you know, we struggled financially. There was months I remember where we couldn't pay the bills and we were having to kind of jump around and find different distributors that would let us buy from them because we had such big debts or they'd come to us and say, hey, can we possibly pay you on Monday as opposed to Friday? And I just remember thinking like, man, these guys are just working so hard and they do such a good job and so many people just love and adore them. And yet we're struggling to pay the bills. And veterinary medicine is not a huge margin industry, but there are things that you could put in place and having a little bit of business sense to it. I thought, okay, if we got in and did this and change these systems, you know, we could get this thing where it's, you know, not having to struggle to pay its bills month to month and maybe be profitable as well. And so that was kind of the initial driving factor. And then. My partner who is also here working as well, felt the same way, like we've got a really good practice, we've got a really good clientele, we just need to put in some systems and kind of change how we do things and we think we could really take this to a different level.
Yeah, and we don't hear that from most hospital owners. They usually don't have as much of a business background, right? It's just like, can you go to school to be a veterinarian? Then all of a sudden you are told you should own a hospital. So I think that's amazing that you had that background and it's probably very helpful. But can you tell us what that was like going from an associate to practice owner all within the same hospital?
Yeah, and I even went from working in the kennels at that hospital to being a doctor and then to being an owner. And so each time, whether it was going from kennels to lab, lab to treatment, and then becoming back as a doctor and then going on as an owner, I think I was fortunate that my dad was always kind of mindful of the fact like, look, you want to go on and be a doctor. You know, you're working in the kennels now but you need to be mindful of what your end game is. You need to respect everybody in the hospital because you never know how those relationships are gonna work in the future. And that was huge for me. And I know not everybody has somebody that could maybe have that foresight, but having him kind of keep that in the back of my mind, like, okay, this isn't your end game was really important because I think I treated people, hopefully the way I would have treated them anyway, but I treated them with respect. I tried to always act as a leader no matter what my position was in the hospital. And I think that paid great dividends because I've seen people who have had a similar situation to me where maybe it hasn't gone that way. Maybe they didn't behave the same way they would have when they were 18 is when they were 25. And that kind of came back to burn them.
So I think one of the biggest struggles that I had with it, though, was a lot of these people were my contemporaries and my friends that I went out with on the weekends and hung out with differently at work events. And now I'm kind of having to take a different step and separate. So that was a struggle for both my partner and I, is like, okay, how do we separate ourselves and have that respect, but also still have that relationship and draw those boundaries. So I won't say it was easy by any stretch, but I think having grown up and kind of moved through the different departments and kind of earning their respect with each transition in the hospital made it a little bit easier when it came time. And at the end of the day, I never acted like I was better than them. I was always part of the team. And even to this day, I don't ever talk about any of them being my employees. They're people that I work with. And I think having that mentality has also served us well along the way. We're all here to do the same thing, whether it's owner or kennel person, we're all here to support one another. And I think that's paid big dividends for us as well.
So I think one of the biggest struggles that I had with it, though, was a lot of these people were my contemporaries and my friends that I went out with on the weekends and hung out with differently at work events. And now I'm kind of having to take a different step and separate. So that was a struggle for both my partner and I, is like, okay, how do we separate ourselves and have that respect, but also still have that relationship and draw those boundaries. So I won't say it was easy by any stretch, but I think having grown up and kind of moved through the different departments and kind of earning their respect with each transition in the hospital made it a little bit easier when it came time. And at the end of the day, I never acted like I was better than them. I was always part of the team. And even to this day, I don't ever talk about any of them being my employees. They're people that I work with. And I think having that mentality has also served us well along the way. We're all here to do the same thing, whether it's owner or kennel person, we're all here to support one another. And I think that's paid big dividends for us as well.
Yeah, thanks for sharing that. Now that you've been an owner for several years, and today's episode, we're kind of really focusing on the idea of owning multiple locations. So in your opinion, do many healthcare providers know going in that they want to be a multi-hospital owner, or is that something they kind of discover after a few years of ownership?
Thinking back to vet school, I can think of maybe one person that I was like, okay, that guy's gonna go out and he's gonna have ten hospitals. They're the head of the student business association. They were running for all the councils. Like you could just tell, okay, that guy or that girl is set up to go on and do big things and have multiple practices. But that was one out of 125 in the class. I think that the vast majority probably didn't even have ownership expectations or desires. There was maybe a handful of us who you knew, okay, that's something that they wanna do. But having multiple hospitals, I think that's something that when you're in vet school especially, where you're not getting any business training, you're not thinking about, okay, how can I manage one? What else, how can I manage five of these practices? I think a lot of people would get exposed to someone like I did in my internship who had multiple hospitals and that was really my first kind of exposure to, this is how he does it, this is what this means for him in the hospital and I could do that. Like that could be an exciting thing to go down that road. And I think most of the people I know that have multiple hospitals had some kind of exposure along the way that kind of led to them realizing that was even an option. Because certainly not something we get taught about or that comes up when you're in veterinary school.
Yeah, we've heard it time and time again on the show about the power of a great mentor, right, and what they can do for your future.
Absolutely.
So I think you hit the nail on the head. What would you say the motivation, or maybe your motivation for wanting to own multiple hospitals is?
Yeah, so I think for us, it started out as, you know, we felt really good about what we had built. We had kind of taken this model that was low cost, get them in, get them out. It was just a very different model, and it fit the area that we lived in at the time. Like there needed to be somebody that kind of met that environment. But at the same time, we knew that wasn't who we wanted to be long-term. And so we kind of came in, recreated the culture, recreated the type of hospital that we were, and we built it into something that we felt was really special from the standpoint of clients really enjoyed coming here. The level of medicine that we were offering was different than any of the other general practices in our area. And doctors really enjoyed being a part of what we were doing. And so we weren't having the same struggles finding veterinarians and finding staff. And so we just felt really good about the product that we had in place. And we had people driving to us from, you know, 20, 30, 45 minutes to come to get these services because it was either come to us or go to a specialist. And so we realized, okay, there's a need in some of these other areas around us for what we're doing. And so that was really when it kind of started, was like, okay, we really can't expand a ton where we are, but we can open up some exam rooms 30 minutes down the road, recreate these systems that we have, and meet a need in that particular demographic for what we're currently doing. So that's where ours kind of came from, was like, okay, we've got a good thing. There's clearly a need for it in other places. We sought out an area that we knew that there was definitely a need for it. We did demographic studies. We really kind of looked at the area and we realized, yeah, this could work here. And that's how we kind of started with our second location.
What sort of niche did you guys build? Because I think that's really important to think about when you're talking about owning a hospital. What specific type of thing do you bring that's different from the competition?
I think what we saw was my partner and I had both done internships. My partner went on to do a second internship in surgery. He had a real love for surgery and wanted to do it at a high level. And so coming out of our internships, we were used to practicing kind of a higher level of medicine. And so we said, OK, vaccines, they've got to be done. Sure. Spays and neuter, they've got to be done. Sure. And there's definitely a need in the community. But you're seeing low-cost spay-neuter clinics come in. You're seeing low-cost vaccine clinics. You're seeing the mobile vaccine trucks come in. And it's really kind of undercutting our ability as veterinarians to produce and grow in a certain way. But to me, and the way I kind of pitch all the doctors that come to us, like, did you go to school because you just wanted to do vaccines? Did you go to school because you just wanted to do spays and neuters? And nine times out of the 10, the answer is no, I went to school because I want to practice medicine. I want to save lives. Like that's what I want to do. And I think that some general practice hospitals are set up that they can do advanced procedures. And that's not to say we're doing things that the specialists should be doing, but there are a lot of things that we're doing that other general practices aren't able to do, be it because of staffing or training experiences or desire. So we've kind of fallen into that niche. I don't want to call it urgent care per se, because there are people that are popping up with an urgent care model that's more based on their hours.
I'd say we're more urgent care emergency day practice from the standpoint of you come in with something that needs to be cut, we're gonna cut it. You come in with something that needs to be hospitalized, we can hospitalize it. We're always gonna offer you to go to the specialist, but we can perform high level procedures. We can do high level medicine in our four walls with the staff that we've got and that we've trained. And so that's kind of become our niche in the areas. You can't afford to go to the specialist or logistically you can't get to the specialist like we can't do it here but go to Cabarrus Animal Hospital. They can do those things, they'll get you in today.
I'd say we're more urgent care emergency day practice from the standpoint of you come in with something that needs to be cut, we're gonna cut it. You come in with something that needs to be hospitalized, we can hospitalize it. We're always gonna offer you to go to the specialist, but we can perform high level procedures. We can do high level medicine in our four walls with the staff that we've got and that we've trained. And so that's kind of become our niche in the areas. You can't afford to go to the specialist or logistically you can't get to the specialist like we can't do it here but go to Cabarrus Animal Hospital. They can do those things, they'll get you in today.
I'm sure your pet owner patients really love that too, not having to go to multiple different locations and all over, right?
Yeah it’s huge. And we've always, even before we got to that level, like we were offering dog training, we had boarding, we had grooming, we always viewed it as, okay, how do we be kind of the one stop shop for these people? And just taking the medicine to another level to us was kind of a no-brainer because that's why we didn't get into this to manage grooming facilities or boarding facilities, but we knew that it was important to our clients to be able to come to us and to get everything that they needed without having to go to five different places.
Yeah, that's fantastic. Let's say that we're determined and we've done our research, that we're ready to open this second location, let's say. Where do you start?
So I think before you open the second practice, you have to make sure that your systems are in place at number one. Because any holes that you have in hospital number one, any holes that you have in your system, they're only gonna get magnified when you go to do number two. And that could be in the second location that it becomes clear, or it could be now you've stretched yourself a little more thin by opening the second location and those systems are falling apart at hospital number one. So I think the most important thing that people need to understand going into the situation, and this is not to say that we know how to do everything perfectly. We've learned a lot because we've made these mistakes is you have to have systems in place. You have to have people in place so that you know that we call it the mothership. Number one is going to be able to sustain when you open number two, you're not going to stretch yourself thin going into number two, because you have all these things that you haven't been addressing or have never properly addressed at number one. Because again, they're just gonna become that much more obvious. Number two, I think you have to understand your data and you have to understand your numbers. Because if you don't have good data and you don't have good numbers and you can't really wrap your head around what the cash flow is, where your money's going for labor and equipment and cost of goods, then you might think you're running a really good business. But then when you start stretching things out across another practice, and you need to support it in any way, it'll become real clear real quick we actually didn't have nearly the amount of money that we thought we did, or we weren't nearly as profitable as we thought we were. So I think the other big thing is, and this is a thing where veterinarians as a whole, I think we're not very good at, yeah, we make enough money to keep the doors open, the lights on, and we think, okay, let's just replicate this in number two. But number two is not just gonna come out of the gate and be profitable. I mean, it's probably gonna take... years potentially before it becomes profitable. And so knowing that number one can support number two if needed, I think is an extremely important situation that people don't necessarily think about, or they think that their numbers are good, but they really don't have their head wrapped around what their actual numbers are. And we've been fortunate that we work with some great accountants and bookkeepers, and I would recommend that to anybody in our industry, even if they don't have aspirations of doing number two, get with somebody that really understands our industry. Our margins are different. What you should be paying for labor is different. What you can pay for cost of goods is different. Because if you're missing those buckets, your ability to be successful in number one is gonna be a struggle, much less going into number two. So I think surrounding yourself with really good people going into that second hospital is also really important as you start transitioning from thinking about the day-to-day of a one, which is, you may still be seeing cases. You may still be doing callbacks on blood work. And now number two, you know, maybe you're stepping out of that role and you're having to oversee some of these other things. Well, you need people who probably are looking at your practice at a higher level. They can say, yeah, this is feasible. You can go and do this. So that would be the other thing I would say, have really good people around you that you can really bounce the idea of going off into another clinic with, because they may be looking at your numbers totally different than you view them, which is, hey, the lights were turned on. We got our bills paid. We can definitely do this in another spot. And then I think the last thing that I would tell people is, why do you want to open that second location?
What's your role going to look like when you open that second location? Because things have to change. When we started this, my partner and I, we were the guys. We were the people that the clients came to see. We were the ones that were producing 75, 80, 90% of the revenue and clients came to see us. And so there was a transition as we started getting bigger where I had to kind of step back a little bit and clients weren't necessarily thrilled with the idea that I wasn't gonna be there. And so for me, I knew long-term, my goal wasn't to be the guy in the room seeing all the patients. That just wasn't where my love was. I knew I wanted to be more involved in the ownership and the management of the hospital. My partner, polar opposite. He wants nothing to do with it. He'll tell you himself, he wouldn't even know how to log in our bank accounts if you asked him. Because he's a fabulous surgeon, he's a fabulous clinician, and people love and adore him, and that's where he is a rock star. And so, I knew that's what I wanted to change, and in order for us to be successful and grow, number one, I had to step out and start working on the business and not just in or at the business, and for number two to happen, it was even that much more important that I wasn't in the practice all day, working in the practice, but I was working at both practices trying to make sure that systems were in place, management was in place, that we were hiring, we were doing everything we needed to grow. And so I think that's really important because a lot of vets get into it because they love working with people and the animals. And the reality of going into a second practice is you probably can't do both excellent. You can probably do both okay, but something's gonna suffer, whether it's your home life, whether it's the practice management, whether it's the callbacks to those owners. You can't do everything excellent all the time when you start getting to that kind of scale. That would be the last thing I would tell people is like, hey, why do you want to do this? Like why the second practice? And are you willing to change who you are in the practice? Or do you need to have a partner that's willing to do that side of it? Or do you hire a manager who's willing to do that side of it? Because you just simply can't do everything all the time really, really well. And it really comes apparent when you get into that second location and it's not just right there in four walls.
What's your role going to look like when you open that second location? Because things have to change. When we started this, my partner and I, we were the guys. We were the people that the clients came to see. We were the ones that were producing 75, 80, 90% of the revenue and clients came to see us. And so there was a transition as we started getting bigger where I had to kind of step back a little bit and clients weren't necessarily thrilled with the idea that I wasn't gonna be there. And so for me, I knew long-term, my goal wasn't to be the guy in the room seeing all the patients. That just wasn't where my love was. I knew I wanted to be more involved in the ownership and the management of the hospital. My partner, polar opposite. He wants nothing to do with it. He'll tell you himself, he wouldn't even know how to log in our bank accounts if you asked him. Because he's a fabulous surgeon, he's a fabulous clinician, and people love and adore him, and that's where he is a rock star. And so, I knew that's what I wanted to change, and in order for us to be successful and grow, number one, I had to step out and start working on the business and not just in or at the business, and for number two to happen, it was even that much more important that I wasn't in the practice all day, working in the practice, but I was working at both practices trying to make sure that systems were in place, management was in place, that we were hiring, we were doing everything we needed to grow. And so I think that's really important because a lot of vets get into it because they love working with people and the animals. And the reality of going into a second practice is you probably can't do both excellent. You can probably do both okay, but something's gonna suffer, whether it's your home life, whether it's the practice management, whether it's the callbacks to those owners. You can't do everything excellent all the time when you start getting to that kind of scale. That would be the last thing I would tell people is like, hey, why do you want to do this? Like why the second practice? And are you willing to change who you are in the practice? Or do you need to have a partner that's willing to do that side of it? Or do you hire a manager who's willing to do that side of it? Because you just simply can't do everything all the time really, really well. And it really comes apparent when you get into that second location and it's not just right there in four walls.
Yeah, and sounds like you found the perfect partner, by the way, between you two.
You know, yeah, and I probably should have said that at the very beginning. I mean, I'm extremely blessed when it comes to my partner. I mean, we could not have a better relationship.
You know, we’ve discussed how you know when you're ready to open additional locations, but when we come back, I'd like to get into more of what it's actually like to manage multiple hospitals. More with Dr. Mike Robinson right after this.
I'm Corey Brown and this is Provide’s the Path to Owning It podcast. We're back with Dr. Mike Robinson, owner of multiple animal hospitals in North Carolina to discuss what it's really like to manage multiple hospital locations. Mike, you've hit on this a little bit, but I think our audience listening would really just like to hear from someone who's done it, how is managing a single hospital different from managing multiple locations?
You know, my role had to change in the hospital. So when I was still seeing patients pretty regularly, let's say half the time, the other half the time that I was owning, we were smaller at that point. And so, you know, half my day would be calling back bloodworks and, you know, getting with clients on questions that they had, updating records. And then the other half would be paying the bills and maybe dealing with a disgruntled client or having to make some phone calls to distributors. That was kind of how things were in the beginning. And the reality was I had to morph because I couldn't spend 50% of my time with clients and really give them what they needed. So it kind of morphed into, I had to be a part of hiring doctors. I had to be a part of hiring staff. I had to be a part of making sure that our management structure was in place and operating the way that we wanted to. I made that intentional decision to kind of move more into the management side of things. And so I have some fabulous doctors that work with me. And as we grew, I added more doctors and I started introducing those doctors to my clients, clients who I knew really love seeing me and were going to be, you know, sad when I wasn't going to be there. I had to have an option for them that they knew that they could trust and they wouldn't leave us because they couldn't see me anymore. So that became, OK, I've got Miss Smith in room one. I know she's going to be sad if she can't see me every time. But the reality is I can't be there for her all the time. Come meet Dr. Kidwell. She's fabulous, you'll love her. I just want you to know if I'm ever not here, she's gonna be here and she'll always take care of you and have that really good handoff experience. And that paid off big time for us in that we didn't have a ton of clients that were just really upset when I suddenly couldn't see their pets anymore because for years they had access to me.
So I think I needed to come to terms with the fact that I couldn't be that guy anymore as much as that kind of hurt to not be the one that everybody was so excited to come see. But I had to plan for that so that they had somebody to go to this. They didn't think that I was just leaving them to go off and manage the business. They had to have somebody that they knew they could be with and that they trusted and that they liked just like they liked me. And so that was a big part of the transition for me was just realizing, okay, I can't do both. Let me make sure my clients are taken care of because that's the most important thing. And then that'll give me more time to focus on the things that I need, which 90% of my days are probably dealing with human resource issues. I think we're over 100 staff between the two hospitals and we're just over 20 doctors. So most of my time is making sure that our people are taken care of, that they're happy being here that our protocols are in place, that our systems are in place. And so that's what my focus has to be. And if I were to try to do that half the time, things would fall apart and staff would leave us because there's no way I could do that in a way that would really benefit them if I was just doing it half the time.
So I think I needed to come to terms with the fact that I couldn't be that guy anymore as much as that kind of hurt to not be the one that everybody was so excited to come see. But I had to plan for that so that they had somebody to go to this. They didn't think that I was just leaving them to go off and manage the business. They had to have somebody that they knew they could be with and that they trusted and that they liked just like they liked me. And so that was a big part of the transition for me was just realizing, okay, I can't do both. Let me make sure my clients are taken care of because that's the most important thing. And then that'll give me more time to focus on the things that I need, which 90% of my days are probably dealing with human resource issues. I think we're over 100 staff between the two hospitals and we're just over 20 doctors. So most of my time is making sure that our people are taken care of, that they're happy being here that our protocols are in place, that our systems are in place. And so that's what my focus has to be. And if I were to try to do that half the time, things would fall apart and staff would leave us because there's no way I could do that in a way that would really benefit them if I was just doing it half the time.
Yeah, I think it's so important that you realize that early on too, and had that handoff like you said. I think that is great advice. You've mentioned employees and staff and multiple doctors, so I think our audience would like to know what kind of office structure do you have that works well for you? Is there like one management group that's managing both practices? Are they run independently? Can you talk a little bit about that?
When we first did this, and I think this will go for anybody as long as you're doing it kind of in a similar area, you know, again, you have to have your systems at number one really fine tuned and ready to go and you have to scale that as you go and you have to be more scaled up than what you are in order to grow. You can't just scale up as it's happening. Like you have to be prepared. And I've talked about, we're going to be overstaffed during times of growth. You can market like crazy and get a bunch of people to walk in the door, but if you're not really ready to meet that demand, they're gonna come in and they're never gonna come back because you weren't prepared for it.
So all along with growth, whether it was in hospital number one or number two, we've always tried to stay a little bit overstaffed when we're in that growth phase. So from a management or a structure standpoint, we've had to do the same thing. We started off with no practice manager when we first took over the practice, and I was kind of in that role to having a practice manager to morphing into needing two practice managers in our larger practice. And then under them we had numerous different lead positions or management positions in the hospital. None of them happened day one, but as we were growing, we could see the need for it as we got further along. And again, we didn't want to be reactive, we wanted to be proactive in those situations. So I think the same thing goes for that second hospital. Once you realize, okay, we're gonna do this, you can't put those people in place after the building's already there and the doors are already open. You kind of need to know what that's gonna look like and have those people in place and have them understand how things work at number one so that they can easily go over to number two and recreate that situation. And by doing it early, they were able to work with our managers at number one and really understand how the hierarchy worked and the systems worked at number one so that they were just going over and recreating the management at number two.
So the way that we run things are, Yes, there's kind of a central management team. My original practice managers have kind of grown to a place where we have people under them that are handling some of the day-to-day that they used to do so that they can focus on some of the larger picture things for both hospitals like inventory, scheduling being two of the bigger things, they kind of view those things for both hospitals. But then I've got a practice manager at number one who's an absolute rock star as well. And she just does everything that my practice managers at number one do and they are constantly in communication. We text, call, have meetings. And so I think you have to build that management team before number two opens and then be able to plug them in and just have more people in place than you probably need on day one so that when people do come in the door, you look like you know what you're doing and you've got the staff there prepared to meet their needs. We do run them kind of as one, but at the same time, and this is one of the things we had to learn, as much as we have these systems that are in place across the two hospitals, they're two separate hospitals. They're two totally different staffs. The clients, even though we're in a similar area, are different, and I think that's something we've kind of learned along the way, is we thought, okay, it's just a couple exam rooms down the road, this'll be the same deal, we'll just run things the exact same way, and to some extent, yes, but no, it's like when you have kids, like yeah, both kids are from the same mom and dad. But they're different. They have their own personalities and they have their own interests. And that's what's kind of happened between the hospitals. And that's something that's been really fun and exciting to deal with. But it's been something that I don't think we anticipated the differences that would happen in some of the decisions and the way we would have to handle things differently between the two hospitals, even though they couldn't be run more similarly. So I think that would be the other thing that I would tell people is like, you got to be nimble and understand that as much as you want it to be like number one it's going to be its own hospital. It's going to have its own personality, and you're going to have to make decisions and changes based on what's happening at number two that just were different than number one. That's been a challenge, but it's been fun. And I think we probably recognize it a little later in the process than we should have. But it's neat kind of seeing the second hospital grow and become its own person, just like your children when they grow up and kind of become their own adult.
So all along with growth, whether it was in hospital number one or number two, we've always tried to stay a little bit overstaffed when we're in that growth phase. So from a management or a structure standpoint, we've had to do the same thing. We started off with no practice manager when we first took over the practice, and I was kind of in that role to having a practice manager to morphing into needing two practice managers in our larger practice. And then under them we had numerous different lead positions or management positions in the hospital. None of them happened day one, but as we were growing, we could see the need for it as we got further along. And again, we didn't want to be reactive, we wanted to be proactive in those situations. So I think the same thing goes for that second hospital. Once you realize, okay, we're gonna do this, you can't put those people in place after the building's already there and the doors are already open. You kind of need to know what that's gonna look like and have those people in place and have them understand how things work at number one so that they can easily go over to number two and recreate that situation. And by doing it early, they were able to work with our managers at number one and really understand how the hierarchy worked and the systems worked at number one so that they were just going over and recreating the management at number two.
So the way that we run things are, Yes, there's kind of a central management team. My original practice managers have kind of grown to a place where we have people under them that are handling some of the day-to-day that they used to do so that they can focus on some of the larger picture things for both hospitals like inventory, scheduling being two of the bigger things, they kind of view those things for both hospitals. But then I've got a practice manager at number one who's an absolute rock star as well. And she just does everything that my practice managers at number one do and they are constantly in communication. We text, call, have meetings. And so I think you have to build that management team before number two opens and then be able to plug them in and just have more people in place than you probably need on day one so that when people do come in the door, you look like you know what you're doing and you've got the staff there prepared to meet their needs. We do run them kind of as one, but at the same time, and this is one of the things we had to learn, as much as we have these systems that are in place across the two hospitals, they're two separate hospitals. They're two totally different staffs. The clients, even though we're in a similar area, are different, and I think that's something we've kind of learned along the way, is we thought, okay, it's just a couple exam rooms down the road, this'll be the same deal, we'll just run things the exact same way, and to some extent, yes, but no, it's like when you have kids, like yeah, both kids are from the same mom and dad. But they're different. They have their own personalities and they have their own interests. And that's what's kind of happened between the hospitals. And that's something that's been really fun and exciting to deal with. But it's been something that I don't think we anticipated the differences that would happen in some of the decisions and the way we would have to handle things differently between the two hospitals, even though they couldn't be run more similarly. So I think that would be the other thing that I would tell people is like, you got to be nimble and understand that as much as you want it to be like number one it's going to be its own hospital. It's going to have its own personality, and you're going to have to make decisions and changes based on what's happening at number two that just were different than number one. That's been a challenge, but it's been fun. And I think we probably recognize it a little later in the process than we should have. But it's neat kind of seeing the second hospital grow and become its own person, just like your children when they grow up and kind of become their own adult.
Can you share one thing that was unexpected at number two that you didn't anticipate?
Culture, maybe? And that's not to say that the cultures are dramatically different, but you know, I love our culture at number one and I give all the respect to the guys that we bought the hospital from and that I started working for. I mean, I changed my life trajectory based on how much I enjoyed working with these guys. We've tried to maintain that very familial culture as we've moved forward. I think we just thought, well, that'll just happen at the second hospital, like the same exact feel will happen at the second hospital. And that just wasn't the reality of it. I think that understanding that, okay, we can have the same common core principles and values and goals, and we can have similar people at both hospitals. But the culture is going to be different. And you're going to have to nurture that culture differently than you do the culture at the first hospital. And again, I think, not that we were late and things fell apart, but I don't think I realized it quite as early that I need to nurture this in a little different way, and I need to handle the people over there a little bit different. Even the clientele, again, we're not far apart, but it's a very different clientele than what we had at the first hospital. So I think that's something people may not realize, especially if you're opening something that's pretty close to your current practice, is that it's gonna be a totally different culture and a totally different clientele coming in the door, no matter how similar you think things are when they're opening.
Do you mind sharing what you've kind of learned about managing such a large staff and attempting to keep that office culture fun and positive like you had mentioned?
Yeah, so when I got to Cabarrus, when I first came here, we would run two, maybe three doctors on the floor. And we might have had eight, nine, 10 staff working during the day. And it was very, very family culture. And I loved it. And the guys that built the practice did a fantastic job, probably at some times to their detriment when it came to a business standpoint. But I loved it. And that's why people stuck around for 20 plus, 30 plus years as a part of that practice. And so, as we grew at Cabarrus, we really tried to make sure that we maintained that. And I think because Blake and I quote unquote grew up in the practice, he was 15 when he started working here, we really tried to do that at Cabarrus. And as we grew, bigger and bigger and bigger, we really tried to make sure that same familial culture persisted. And with number two, we tried to do that as well. But I think honestly, where we met our biggest struggles with that was COVID. Things got so crazy during COVID, where we were interviewing people that normally would not have even gotten an interview. And we were hiring people who we definitely probably wouldn't have hired, not because they were bad people, but because they had zero experience. You know, COVID was mayhem for veterinarians for a pretty extended period of time. I mean, people saw 20, 30% increases in their invoices and the volume was just something we had never had to deal with. So I think during that time, we brought in lunches every single day for our staff for almost two years. I mean, we did everything we could to take care of them and keep that family sense there. But so many people got added so quickly that I think we lost some of that familial feel and where it really kind of manifested was honestly just in the last probably six months, we had a situation where, and you'll have this as owners, where you'll have this kind of ebb and flow in the hospital culture, where one day you think everything could not be better, everybody couldn't be happier, and that'll persist for months, and then it's like one day you wake up and the sky is falling, everybody wants to see you at lunch or do I have a minute to talk, which you never know, it's never usually a good thing.
And it's like, oh my gosh, where's all this coming from? And there was this kind of underlying sense of there was a disconnect between the employees and management and ownership. And we wanted to sit there and be like, oh no, we've been doing all these things, we've been taking care of these people. But when we really stepped back and started talking to our management team, we realized like, yeah, there's a personal side of this that we've always managed to maintain that we've lost. And some of that was the employees that we'd had for 20 years, 30 years, maybe some had retired, maybe some during COVID decided they didn't want to come back. Maybe we just added a lot of people that weren't here before, but they didn't have a history with us. They didn't have this history of these guys always take care of us, or this is a big family.
And so when the going got tough, there wasn't that same trust that we had historically had. And so for the first time in a long time, we really had to take a look in the mirror and say, OK, like, We've got to get back, even though our staff has gotten this big and we're this busy, we've got to get back to a place where these people feel comfortable coming and expressing their concerns, coming to us when they have issues. One of the things we kept hearing was like, I'm scared to come talk to you guys, right? I don't know you well enough to say these things. And that was a real gut punch because for the first time in our careers, somebody wasn't comfortable coming to us. And that was on us. I mean, we had to fix that.
And so we've taken some steps recently to really kind of close that gap between them and management and them and ownership. And I think that was probably the first time as we've scaled, we had lost touch a little bit with what was happening as we had added so many new people. And I'd like to think if COVID hadn't happened and the scaling hadn't happened so quick, maybe we would have been more in touch with it and it wouldn't have happened the way that it had. But you know, we're learning from it and we're learning that we have to kind of manage a newer generation a little differently than we did before. We have to manage people who don't have a 10, 15 year history with us a little differently than we do somebody that just walked in and has never worked in the vet industry. And so it's been a good learning curve for us. But it's definitely something we had never experienced on a much smaller scale.
And it's like, oh my gosh, where's all this coming from? And there was this kind of underlying sense of there was a disconnect between the employees and management and ownership. And we wanted to sit there and be like, oh no, we've been doing all these things, we've been taking care of these people. But when we really stepped back and started talking to our management team, we realized like, yeah, there's a personal side of this that we've always managed to maintain that we've lost. And some of that was the employees that we'd had for 20 years, 30 years, maybe some had retired, maybe some during COVID decided they didn't want to come back. Maybe we just added a lot of people that weren't here before, but they didn't have a history with us. They didn't have this history of these guys always take care of us, or this is a big family.
And so when the going got tough, there wasn't that same trust that we had historically had. And so for the first time in a long time, we really had to take a look in the mirror and say, OK, like, We've got to get back, even though our staff has gotten this big and we're this busy, we've got to get back to a place where these people feel comfortable coming and expressing their concerns, coming to us when they have issues. One of the things we kept hearing was like, I'm scared to come talk to you guys, right? I don't know you well enough to say these things. And that was a real gut punch because for the first time in our careers, somebody wasn't comfortable coming to us. And that was on us. I mean, we had to fix that.
And so we've taken some steps recently to really kind of close that gap between them and management and them and ownership. And I think that was probably the first time as we've scaled, we had lost touch a little bit with what was happening as we had added so many new people. And I'd like to think if COVID hadn't happened and the scaling hadn't happened so quick, maybe we would have been more in touch with it and it wouldn't have happened the way that it had. But you know, we're learning from it and we're learning that we have to kind of manage a newer generation a little differently than we did before. We have to manage people who don't have a 10, 15 year history with us a little differently than we do somebody that just walked in and has never worked in the vet industry. And so it's been a good learning curve for us. But it's definitely something we had never experienced on a much smaller scale.
Yeah, I mean as someone who has worked for doctors for many years in the past, I think it's so important that you listen to your managers and really take that in. I think that's probably the biggest piece of advice I could give an owner.
You've given so much great advice today. I'm not sure if we can narrow it down, but is there one piece of advice that you could give our associate veterinarians and our single hospital owners listening today who have dreams of owning multiple locations?
Really the biggest thing, just knowing my classmates and knowing the people that I work with on a day-to-day basis who have zero interest in owning a hospital, much less multiple hospitals, you know, why do you wanna do it and what's your role gonna look like as you move forward? Because if you still wanna be the vet and you still wanna be the person saving lives on a day-to-day basis and you still wanna be the person that when you go to the grocery store, hey, there's Dr. Mike, like, oh my gosh, you helped Fluffy. Like, if that's part of who you are, and that's your why, then maybe owning multiple hospitals isn't for you, but if your why is like, I like the management, I like the ownership, I like creating systems, I like creating an environment where people love coming to work for me, and where we provide an amazing service for the community, but maybe I'm not the person on the ground doing it, then okay, yeah, like this may be the path for you, but I think it's really hard to have your cake and eat it too in that situation because people expect a lot from their veterinarians. You got to be willing to go in one direction or other if you're really going to scale or have a partner who that's what they're passionate about or a manager who's passionate about those things and you can stay on the floor and be a producing veterinarian while they handle all that.
Mike, that's great advice. Thank you for sharing. You know, for those who may be interested in joining your team now, I'm not sure if you're hiring, but what's the best way for them to reach out to you?
Yeah, so, and I didn't say this anywhere in the interview, but I don't remember what book or who told me along the way, always be hiring for tens. If somebody great walks in the door, I'm gonna hire you. Just whether we need you or not, I'm gonna hire you. Now, having an idea of your data and your labor and all that's obviously important because you can get a little carried away with that. But if a fabulous doctor that fits our culture that my clients are gonna love walks in the door. I don't care if I have plenty of doctors in the stable. Like that person's gonna make us better. And it's not necessarily the, if you build it, they will come thing. But in the veterinary medicine, we're fortunate in that there is a need for veterinary care. And so when somebody awesome walks in my door, whether it's a receptionist or a kennel person or a doctor, we're hiring. If you fit that need and our culture sounds like something you'd like to be a part of, or you wanna own a hospital and you'd like to partner with us, like we're all for it. You know, Cabarrus Animal Hospital, HarrisburgAnimalHospital.com. We're on Facebook, we're on Instagram. Send us your resume. We keep ads out for doctors on the North Carolina Veterinary Medical Board site. We're always looking for staff on Indeed, like whether we have enough people or not, we're always hiring for those tens.
Awesome. Well, Mike, thank you for being with us today. It's clear we found the right person to discuss how to grow from one hospital to multiples. And being able to hear it from someone who's done it so successfully is just really valuable to our audience. So we appreciate you taking the time.
Yeah, I appreciate you having me. It's been a lot of fun.
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The Path To Owning It is brought to you by the team at Provide.
And it’s produced by Podcamp Media, branded podcast production for businesses. Pod-Camp-Media-Dot-Com. Producer Dusty Weis. Editor Will Henry.
For Provide, I’m Corey Brown. Thanks for being on the journey with us.
Provide, Inc. is a wholly owned subsidiary of Fifth Third Bank, National Association. All opinions expressed by the participant are solely their current opinions and do not reflect the opinions of Provide, its affiliates, or Fifth Third Bank. The participant’s opinions are based on information they consider reliable, but neither Provide, its affiliates nor Fifth Third Bank warrant its completeness or accuracy and should not be relied upon as such. This content is for informational purposes and does not constitute the rendering of legal, accounting, tax, or investment advice, or other professional services by Provide or any of its affiliates. Please consult with appropriate professionals related to your individual circumstances. All lending is subject to review and approval.
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