Episode 10: Dr. Sara Pizano & Aimee St Arnaud – Open Door One Health

Dr. Sara Pizano & Aimee St Arnaud

Dr. Sara Pizano & Aimee St Arnaud

In this episode, Dr. Sara Pizano with Team Shelter U.S.A. and Aimee St Arnaud talks about the Open Door For-Profit model and the Open Door One Health national mentorship program.

With more than 30 years of experience as a veterinarian in animal welfare, Dr. Pizano uses her expertise in shelter reform to become a positive force in helping shelters of all types and sizes, as well as similar organizations, to reach their full potential. She has teamed up with Aimee from Open Door Veterinary Care/Community Pet Care Clinic for the implementation of the Open Door One Health national mentorship program.

Through the mentorship program, Team Shelter U.S.A. and Open Door Veterinary Care/Community Pet Care Clinic give vets more tools and resources to allow pets to get the quality of care that they need while still allowing veterinarians to get paid and make a decent living wage.


Interested in learning more about the Open Door For-Profit Model?

Connect with Dr. Sara Pizano at http://www.teamshelterusa.com/ or with Ms. Aimee St. Arnaud at http://www.opendoorveterinarycare.com/.


Have questions for Team Shelter U.S.A.?

Follow them on Facebook: https://www.facebook.com/teamshelterusa

Hi, everybody, and welcome You’re tuned into the animal Innovations show. My name is Dr Sarah Prasanna Team Shelter USA. You’ve tuned into the animal innovation show where we feature people, products, services and ideas that are helping animals and the people who care for them live better lives. If it’s innovative, and if it helps animals, you can find it here first. So get ready. Here comes this week’s newest innovation for animals. Great. Well, thank you both for joining today. This is our first three person interviews. So, Dr Pizano, I’m going to let you introduce yourself first, tell us who you are and how you’re innovating to help animals. Wow. So we feel very honored to be the first deuce, um, on your show again. My name is Dr Sarah Paisano and founder of Team Shelter Us A. I’m a veterinarian in animal welfare for more than 30 years, and for the last seven years I’ve been doing shelter assessments around the United States and have really found that no matter where shelters are, what geographic location size budget, whether they’re municipal or private, every one of us is struggling with the same animal welfare issues and The beauty of our work is that the solutions are the same. So we have done now over 100 assessments and happy to say that there is no longer programs. What we talk about when we’re talking about best practice implementation is we know it’s going to work, guaranteed to work. So I am so happy to be partnering with Amy ST Arnaud from Open Door, and Amy and her partners actually opened to for profit clinics to prove that you could marry access to care with a for profit, financially viable business. And in my opinion, this is the future of veterinary medicine. So I am on board and I want to have a me introduce ourselves as well. Thanks, Doctor Fasano. I actually have a background in non profits. And so I worked for the S P C, a spay neuter alliance where I was lucky enough to help build a mentorship where we help train over 170 clinics that now perform over 1.3 million surgeries a year for spay neuter. And we really built this model up to show that it can be done. High volume spay neuter can be done safely and effectively when at a time before no one thought it could be. And we did that through mentoring. And we really believe mentoring is the key, having somebody to show you how to make those changes, how to implement life saving strategies. And so when we saw that that worked with spay neuter, when we started seeing that there was a great need for access to care and full service veterinary care. Yet there was often a lot of conflict between private practices and nonprofits in terms of who should provide the service and how should they do this? So we said, there’s gotta be a way to make this work together. So we set out myself and three other business partners set out to do a for profit private practice. We have two of them now, and I’m happy to say we have been able to show that you can make a positive net revenue and still help increase access to care and keep pets and families together. So we’re using what we’ve learned in the nonprofit model, and now we are ready to show others how to do this across the country, and that’s where I get to work with Dr Paisano. Yeah, this is great. I love this idea. I love what you’re doing is you’re really blending. So I’m gonna start out with a basic question, and I’m going to just start Doctor Pizano first here. You know, we use the term and animal welfare access to care. But what does that really mean for people that are listening and watching? Yeah. So in my work during assessments, this is the number one issue that we see when we see animals coming into a shelter, those owners surrenders. We know about 20% of animals entering shelters are surrendered by their owners. And in 2015, the A S P. C A did a study that showed 80% of them. Chris didn’t want to. They just need a temporary help. And so what I find in these communities that I’m helping is there’s no avenue for those people. And so to us, this is a bridge between the need, which Amy can talk to the numbers. You know, tens of millions of pet owners live under the poverty rate, so we need to be set up to make sure all pets and people are staying together and getting the basic care that they need and the beauty and why. This is the most important model, in my opinion in the country. His open door is a sustainable model. Chris. It’s not about just keep funding, you know, a nonprofit and just keep asking for donors and struggling to get, you know, have ends meet. This is a sustainable model, and that’s why it’s so crucial, so desperately needed to keep animals out of shelters, of course, but the need Amy can speak to, I mean, just the state of our economy and pet owners. And obviously this is not a new thing, but it’s really exacerbated during covid, so I’ll let Amy speak to that as well. Amy, talk to us a little bit about how the model works, and you know what you learned thus far because, like you said, your background is a nonprofit. So how did you kind of make the leap and the blending into a for profit model? We definitely saw the need. Not only were we getting us that a lot through the spay neuter clinics of can you do additional care for seeing it at shelters that the number one reason my animals are being surrendered to shelters is for cost of medical care, and they, like, Dr Prasanna said, They just need a lot of times we could keep them out of shelters and keep them in homes. Why take the resources to have to re home that pet who is going to be scared going into a shelter, place them into another home? And they already had a loving home who was just a little bit of support and help could have kept that we often think, I think in this field I hear this a lot. If you can’t afford a pet, you shouldn’t have one. And the reality is is we’re all one disaster, one pandemic away from being in a situation where maybe we can’t afford our pets. And now when we’re seeing these numbers, that of of how many people have lost their jobs and unemployment, if we don’t even know what’s still to come, I think we haven’t even seen the tip of the iceberg yet. In terms of the need that 59 million pets are living in households that make under 20,000 year and one in four people have experienced a barrier to getting veterinary care in the last two years, so that really says there’s a mean. So what we really looked at doing is how can we still buy? Because obviously, veterinarians have high overhead costs. You can’t give everything away or you won’t be able to keep your business alive. So how can we actually provide that care and still be able to keep our doors open and cover our costs? And that’s really what we started looking at is what efficiencies could be put into place. What financial support systems could we put into place and what partnerships can we build? Because no one organization can do this in love. But when you start bridging the non profits and the animal shelters with the private practices and with the human health care and the social workers, now you’ve got a really robust, comprehensive model that’s going to work for the entire community. And so that’s really what we’ve been doing is is testing and seeing what works and what doesn’t and being willing to try and innovate. And sometimes that’s hard. It’s not. Everything always works, but we think we found something now that can be replicated, and we’re not trying to change what people are already doing. We’re trying to give them added resources and tools to help keep those cuts and families together. What would you do if your cat stop breathing? Would you be able to check their pulse or perform rescue breathing and CPR in time to save their life? Getting certified in cat first aid and CPR is essential to being prepared in case of an emergency. That’s why the Animal Rescue Professionals Association teamed up with Denise Fleck, the pet safety crusader, to bring you the courses and certifications you need to be prepared. Their cat First Aid and CPR course will teach you what you need to know about how to find your cats, pulse and respiration rates and how to conduct rescue breathing and see PCR if required. You also learn how to deal with other emergencies like snakebites, bee stings and tick removal so you can render the age or pet requires. Learn more at www dot animal rescue professionals dot org and get certified today. Now you have two locations now, you said. So where are the locations? Kind of Why were those the first two and maybe what have you learned? Yes, we have one in Toledo, Ohio, which is basically because I’m based here and we wanted to have want to pick a site where we knew that one of the partners were so that we could really be hands on and make sure that this was working. And then our second one is in Asheville, North Carolina. So those are two. We’ve been open for four years in Toledo in two years in Nashville, and we’ve been able to make a profit at both of them, which is great to be able to show others that this can be done. But we’re really finding that while there are differences between the two regionally and so we expect to see that in other areas as well. The same basic premise is the same. You know that offering additional resources by having financial support. So it is not just if someone comes in and they don’t qualify for care credit and they get turned down that that’s it, that the answer is that you have to surrender your pet. There’s other safety nets. We walk them through the next step of the process to meet them where they’re at. And I think that’s really what this is about, as it is about trying to meet people where they’re at in their budget at that point in time and see how we can do this. And it’s not about cutting corners or providing less quality care. It’s about really looking at what efficiencies quit. How can we take a step by step? So a lot of things we do are very simple, as that might be. Something instead of filling a prescription and house, which is going to cost more money. We’re going to go through Good Rx or we’re going to script that out for someone. You know, we do a lot of things where we treat carbo outpatient instead of in patient, which saves a lot of money. But we still are having the same success rates as we are when we treat in house. So it’s really just kind of really looking and trying to How can we remove that barrier? There’s this barrier. This is the way it’s always been done. What can we do to get around that and come up with something else? Dr. Paisano as a vet. I know one of the challenges we hear an animal welfare from vets is they’re trying to run a business, right? They’ve got their own job. They’ve got their loans and things like that to pay off. And often we’re just saying, Hey, you should just help us. So what part of this model really gets you the most excited, right, Chris? Because that is the struggle. So the private veterinarians historically have been approached and by nonprofits, maybe rescues and even clients saying, Well, can’t you discount? And you love animals and you should discount. And you know, if I go to a restaurant and order a meal, I don’t say, Well, I don’t have enough for the steak, So I would like you to discount that for me. We don’t do that in retail, but why we do that in veterinary medicine is because veterinarians are obviously caring, loving people, and that has been the struggle right, that I have to have a business. Um, so that’s why the open door model is so perfect. Because the veterinarian makes the competitive salary, they can pay their staff a competitive salary, and all of those things that are on the business side of it. But on the other side, the client side, there’s several key things that are happening. One. We’re going to really pay attention to incremental care. So if the dog comes in vomiting, I’m not going to give them $1000 work up out the door, you know, right at the get go, we’re going to see their temperature is normal. They’re not critical at all. We’re going to be easy stuff first. One of the other things that I think is most significant. Chris’s veterinarians have been burned by payment plans, right? So veterinarians typically don’t have payment plans. And what Amy and her colleagues did it open Doors said, Well, we’re going to outsource that to accompany and they’ve had great success with payment plans. And not only that, they weren’t just able to capitalize on the payment plans for their existing clients. Guess what? It attracted new clients that didn’t even need the payment plans. It’s nice for them to have that backup because some people weren’t going to the vet because they just knew it was going to be too expensive and they couldn’t afford it, they might feel pressured. So this model is about not judging people like Amy said. Meet them where they’re at, and I just think it truly is the future veterinarians. I hope there’s private practice veterinarians listening to this. This is the way that you can continue to have a great business, a sustainable model with managing, and it also managing the cost of doing business. So, Amy, what is the vision for this? Is this something that’s going to roll out to shelters across the country? Is it going to roll out to vets? Office is I mean, I know with access to care we often talk about. There’s just resource desserts. We call them right where there’s not enough offices. So what’s the vision for how this works? Yeah, exactly. We want to roll this out to private practices and the non profits and show them how to do this together. Because, as Dr Prasanna said, one of the biggest things that we have often seen is that veterinarians do come under fire and they get negative. Google reviews people go after them negatively, saying You don’t care, and that’s like a dagger to a veterinarian’s heart who got into this specifically because they love animals, but they can’t give everything away. And so there’s a very high veterinary suicide rate. This is a very difficult field to get into. There’s a study done in 59% of veterinarians that they wouldn’t even recommend somebody going into veterinary medicine because of all these stresses. So what we want to try and do with this was not only help the pet owner and keep that the pet in the home so they don’t have to make a horrible decision of euthanizing simply due to lack of funds are surrendering a pet. We also wanted to help the veterinarian be able to say yes and not have to say, I’m sorry we can’t help you because that is just heartbreaking for them as well. They want to be able to help all of these animals. So this gives a way to do that because what we found is most interesting. About 10% of our clients can afford our prices as they are, and then about 80% of them can afford it with just a little bit of help. So, like Dr Prasanna was talking about, if we have just a payment plan or a pre savings plan, or we work with them financially to give them a little voucher to be able to help with. The local humane society can provide those types of things, allow them to get the care they need and allow the veterinarian to still get paid and make a decent living wage. So that’s what we’re trying to do is give the veterinarian more tools and options. So we’re not trying to change the way they practice medicine. We’re just trying to give them more options and resources to be able to say yes and to make it easier for them, as well as make sure those clients get that care. So, yes, we’re rolling out a mentorship program where people will be able to do things virtually over the Internet. But we’ll also be able to do some in person once covid allowed. So we’re really excited about this and being able to share this out, and we’ve already done a couple of test consults, and we’ve had great success with the two that we’ve done so far. When you talk model, this is something that should be easily replicated, right, so the procedures, the approach you think about a business and it is those processes those repeatable processes and procedures. And what do you do if is that the kind of stuff that will be provided as a part of this to the participants? Yeah, we’re not looking to teach them how to practice veterinary medicine. They already know how to do a mass removal or how to do a foreign body surgery. So we’re not teaching them how to do that. A lot of it really is around the financial conversation. That is the number one barrier to veterinary care in this country. And so a lot of it is really cracking that nut. And how do we provide these tools and resources? But we do have other things as Dr Prasanna mentioned about how to do the incremental care that fits within a budget, still allowing you to practice medicine. But doing it is a step by step approach to get that animal the care they need. And then we have some really interesting things that we do just in terms of efficiencies within the clinic, how we utilize our veterinary technicians to their highest capability, which they love it allows them to do their job, but it also allows us to be really efficient how we do our inventory efficiencies. But some of the other cool partnerships that we’re doing is how can you work instead of non profits and private practices? Is seeing each other’s adversary or private practices is seeing as nonprofits as unfair competition? How do we leverage that? Were nonprofits can really play a role in helping with medical funds and helping refer and helping do the outreach in the community to meet the clients, provide the transportation or help with the medical fund? And how, then, does each of those play their own role? How do you work with social workers? We’ve integrated a social worker into our practice who actually helps clients with grief counseling and calls them after euthanasia Is there during that? If we need, but also is there to support our staff in terms of how to have some of those difficult financial conversations. So we’ve really been able to tie a lot of these different pieces together, and as Doctor Rosano said, I think that we’ve come up with something that isn’t going to take a lot of extra time, but it’s actually going to make it a lot easier and to not have to turn your clients away. We know you love animals, but maybe you’re not sure how you can get involved. To help save the hundreds of thousands of cats and dogs needlessly euthanized every year. Did you know there’s one place you can go to to sign up as a volunteer, transporter, foster or even social ambassador for rescue animals? Joubert dot com is custom built by animal rescuers. For animal rescuers, you simply create a profile and choose the ways that you can help. Joubert is proud to support more than 5000 rescues and shelters and more than 30,000 duper tears. Just like you working to save animals, join us and you can save lives simply. Go to www dot google dot com to get started today. Dr. Prasanna when you’ve talked to other vets, how do you get them to get on board with this and understand this right? It sounds kind of like Nirvana, where you can help all the animals. You can help people to keep their animals, and yet you’re still going to be able to make money and sustain the living and all those other kinds of things and grow your practice. Right now, I’ve been working exclusively with shelters and from the shelter side. So moving forward what I feel the conversations will be. And I believe Amy has had Is this a as if it was a private practice owner? I would want partnerships. Number one, I would want to say yes. So here is this plan and why wouldn’t you want this sustainable model when you’re providing more care to animals who might not otherwise get it? Plus, nobody’s coming in to ask you to discount your prices or give you a lower profit margin. That has been the issue, and you can’t blame private practices because there are busy. But the business model, I suggest, is not set up for access to care, right? It’s set up for we can send you for the MRI and the specialist and on and on. As you know, the veterinary industry is extremely mature, so the costs have gone up with it because insurance isn’t similar as it is in human health, right? So those costs are passed on to the client, so I think all of these pieces. Listen, you won’t have people coming to you for discounts. You’ll be able to say yes more. You’ll have support. You’ll have. You know, this will actually give you a better perception in your community. Who wouldn’t want to do that? It’s to me. There’s no downside to any of it. And I think another thing, Dimension Chris, is that we also have what we call stay together fund. And so we take a dollar from every one of our exam fees, and we put it into the State Together fund. So we actually have clients who come to us because they like to support a business that’s giving back. So a lot of our clients who can’t afford to pay full price love that that is being done as well and that it is allowing other people to get the care they need. But like I said, the majority of people can’t afford care if they just have a little bit of help. So when you start to recognize those those things of sometimes they’re going to tell you. And so when you start to recognize what some of the queues are that somebody might need financial, and you offer that by offering payment plans. It has. It’s brought in more business for us. People want to support because of what we’re doing, and then that allows us to give back to that last 10% who really, truly needs the help who can’t afford the care. So, you know, is it Nirvana? It definitely is a lot of hard work. I’m not gonna lie. It is, You know, you really have to rethink things. You have to get everybody on board. It is a whole new way of doing it, and that change is not always easy. But I really believe that we’re going to have to do this as a field because more and more financial constraints are going to be an issue as we move forward. So we’ve got to start looking at this now. I agree. And the other thing that Amy didn’t yet is that there’s clinics near her hospitals that refer to them. So what we’d rather do is have them have the same model because they might just refer clients because they have no money or they don’t have enough money recommending so they are hitting referrals. But you know, maybe for the wrong reasons, right? So we would love those practices to also adopt these models. I mean, have I would just like every private practice to adopt these models. Yeah, exactly. So, Amy, what does the future look like? What are the next steps and and making this really take hold and roll out? Yeah. So we will actually be enrolling a website as well as a support network. So there’s going to be some online tools and resources that people will be able to go through, and then they will be able to contact us through the website and sign up for a consult. And so just to see, you know, we’ll be doing some initial free consult like an initial 20 minute talk with you, just to see if this is the right fit for your hospital. And then if you decide it is, then we can set up where we will actually work through how to implement these and again, people can start small if they are ready to do the entire comprehensive package. But they literally just want to start one piece of it. We can work with them on that. The goal is really to spread this as far and wide as possible and get as many communities across the country to increasing access to care so that we can keep those pets and families together. And we’re also working on grants Chris to support these organizations so that we can kind of get jump started to get the program going. So stay tuned. Hopefully we’ll have exciting news for you in 2021. Yes. You have to have this back on. We can join. Yes. How many? How many there are across the country? Yeah, exactly as it really takes hold. Well, I really love this idea. I think it’s really cool and very, very innovative. I love the idea that you’re recognizing the for profit model side of things. I mean, people need jobs. People have to make money too. Same business businesses can’t just completely run as nonprofits forever like you talked about. There has to be a revenue model. So I really like the fact that you spend all this time and really challenge the status quo and say, Well, there’s gotta be a way to do this. How do we blend this? So I’m excited to see where this is going to go and how it’s going to roll out and really revolutionized the way that we look at vet care and keeping the animals with their owners open doors. The destructor like uber. Yeah. No, I really think this is gonna be cool. So, Dr Pizano, why don’t you just, you know, I’ll let you kind of wrap this up. Is there anything else you wanted to share or talk about today? Just listen. If there’s private veterinarians listening or if you know a private veterinarian that you think would be a good fit for this model, we would love to hear from them. We’d love to help plant more hospitals, but we need the veterinarians. We need those on board before we start. If we’re doing an individual clinic, we need the veterinarians to be committed and again. To me, it’s there’s no better way. There’s no better answer than to be sustainable, right? Right. And if people want to learn more about you, Dr Paisano and Team Shelter USA, where can they go? Then go to team shelter usa dot com. I’m on Facebook at Team Shelter USA. They could also buy the best practice playbook for animal shelters. And that’s available on Amazon. Great. And Amy, what else would you like to mention before that? Things up. Thank you for having us on and for sharing this. You know, I do think that sometimes, yes, being a disrupter, it can be difficult at first. Change is difficult for people, but I think that we do have to realize that we are going to have to change because the financial needs are going to continue to rise. And we are not going to be able to continue to practice medicine the way we have. So if we start to embrace these things now, we’re going to see what an impact they can have. And we like to think of it as opening the door to access to care across the country so people can reach us at open door veterinary care dot com. Great. Well, I want to thank both of you for coming on today, Amy. Thank you so much, Doctor Paisano. Thank you so much. And thanks for being the first dual interview today. So we’d like to remind our viewers and listeners that if you’ve got an idea for an innovation that would help animals or somebody that I should talk to. Just go to innovations that show and let us know about it. So thank you again, ladies, for coming on. Thank you. Thanks for joining us for the Animal Innovations show. If you want to volunteer to help animals, check out dilbert dot com where you can join tens of thousands of do for tears supporting rescues and shelters around the world to help animals. And if you know, if something or someone innovative that’s helping animals, let us know by going to www dot innovations dot show.


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