Hi everybody and welcome to another special edition of Vet Chat to celebrate World Congress of Veterinary Dermatology 9. Now for each of these special edition podcasts, we're joined by people that have really specific subject matter knowledge. And in this particular group of episodes we're looking at the Siva symposium, and I'm delighted to be joined by Doctor Natalie Marks, who joins us all the way from the States, which means that at the time of day that we're recording this, I've dragged her out of bed.

I'm midway through my working day, so thank you so much for joining us, Natalie. She's a small animal vet, she's a previous owner and current medical director of a hospital in Chicago. She's a certified veterinary journalist since 2018 and is a recognised national speaker, educator and media campaign spokesperson for many industry partners.

She recently received the The prestigious America's favourite veterinarian award, and No BBA Veterinarian of the Year. She's a particular interest in pet ownership, practise development and how to create a strong relationship with the clients as a vet. So, safe to say, Natalie, that's a fairly strong position to be coming from when we're looking at.

Such a topic of social trends in pet ownership. And obviously, pet owners all over the world are different, you know, there's different trends in the US to the, to the UK, to Australia, to South Africa, to India, and, and, and China. So, first and foremost, what would you like people to take away from your talk at WCBD 9?

Well, thanks again for having me. It's really great to be with you and, and colleagues around the world. I, I think that what we need to understand is that how we used to practise, whether you're in Chicago like myself or in any of the other.

Countries where veterinary medicine certainly has a priority amongst pet owners, what we used to do is not going to work, for in the future that we know from many different countries and different surveys that have been done. That pet ownership is now becoming much more of what we consider pet parenting. It is not considered this property that we used to think from a legal perspective and certainly also sometimes from a medical perspective.

But now that we see this trend of what we call this interspecies family, where a lot of pet parents are choosing to not get married, but instead, cohabitate and have a pet as their child, instead of actually having human children. We're seeing this trend so much more. We need to adjust.

To then understand the sociology and the psychology of where these pet parents are coming from because it absolutely shifts the way that they interact with us and our teams, how they think about decision making and certainly the emotions that go behind decision making for the medical care for their pet. Yeah, and I think that, that to me is, it's fascinating, isn't it, really, watching the relationship between owners and pets, and, and of course those of us who are vets and vet nurses and vet techs, and anybody who's involved in the veterinary profession are almost sort of er caught in a rock and a hard place because I know that from my, my pet owner relationship with my spaniel, he is very much my confidant, and I would do anything for him because he's the only one in this household that doesn't tell me what to do. But.

That, that is, you know, God knows I'd be a lot richer if I only had a spaniel in my life, but at the same time, you know, there's there's such an integral part of, of our, our lifestyle now. Is that, is that a generational thing? Is that a, you know, we're looking at the plight of the world and of course you only have to look at stuff now and you, you see how much more that millennial generation is actively.

I dare say even concerned about factors like global warming, deforestation and things like that, and you know, when I listen to conversations with them, they actually touch on things like, you know, actually we don't want to have kids because we're worried about the state of the world and, you know, people that previously would have had 3 and 4 kids and now just having 1, maybe 2, and you know of course that. Leaves a bit of a gap that for for pets to come along and and and fill, but what's been your, your take on the the relationship for us as veterinary professionals, you know, how has that changed? Well, I think you bring up a lot of great points.

You know, there are certainly generational differences in how pet owners or clients look at their pets and their relationship with their veterinary hospital and their medical care and, and priorities behind that. What we do know is this Millennials are now the top owning pet parent group. Whether, again, you're in the States or elsewhere, they are the ones that are driving trends.

And I feel bad in a way, because I feel like millennials have had sort of a bad rap at times within the industry of, all these changes we need to make to accommodate this new pet owning group and large pet owning group. But I think you bring up so many important points that should hopefully We, we hope will trickle over and spill over into importance in other generational groups, like the concepts of naturality and sustainability and recyclability and all of these issues of transparency that are thankfully driving companies to be more open and disclose more about their products and the safety and where things are being sourced from, which is very important to the millennial. Parent.

You know, you mentioned, is this across all groups. You know, it's predominantly millennials and Gen Zs, but we do see now baby boomers and seniors who are these empty nest parents, now shifting into this pet parent group, where before, maybe that, you know, that dog was part of the family and everyone loved it. But of course, they're raising kids and now the kids are out of the house and we have Back almost to that millennial thought process of two humans and a pet as the family unit now in that home.

And we're seeing increasing trends in spending of those baby boomers and, and, and also the 75 and older group, which, as I mentioned in my talk is really heartwarming for me because I adore seniors and I, my. Clientele is, is quite, quite predominantly senior based, and I enjoy working with them, but we're seeing this ever-increasing trend of assisted living and group centres now allowing pets, seeing the physiologic benefit to seniors of having to be able to reduce blood pressure and, and exercise and encourage movement and all of these things that are extending life and quality. So I, I do think that we as a profession really need to truly understand and embrace that millennial pet parent group if we want to be successful and certainly grow our practises and our business and encourage that human animal bond.

And perhaps those views are not necessarily your own views, but we need to respect and understand that this is where this pet parent is coming from, and these are the ideals and priorities that are important in decision making for their pet. So there needs to be a compromise between the industry and a shift forward into understanding how do we communicate in a way to these millennials that #1, they want and they will receive and respect, but number 2, communicate the ideals in our recommendations in a way that also again shows the importance and that we respect their priorities for you. And when we're talking today about dermatology.

It's really shifting again into those four very important concepts that millennials want again, and that's naturality, sustainability, and recyclability, that safety and transparency truly of of companies, and also how we use our digital behaviour to better communicate with them. Mm. And I think obviously, in, you know, in practise, one of the most common, Diseases we're presented with is, is, you know, skin conditions, you know, I, I don't think any of us can genuinely say in practise, I've been through a whole day, other than if we were hiding in a hole out the back and not seeing a skin case, or even if the owner doesn't think it's a skin case, they come in and you go by the way, were you aware of this skin or coat condition.

So, you know, it forms such a huge element of what we do as clinicians that it's actually a huge opportunity for us. To build that client bond, and, and obviously, you know, we know that there's this behaviour for this new generation of pet owners to say, look, I will do the best for my pet, and, and you know, it is genuinely, I think we used to flippantly say when a pet owner comes in and goes, money's no object, you sort of panic because you know, that's because they don't know money. But at the same time, genuinely they go above and beyond in terms of, you know, their, their spend, you know, they're very much part of this subscription era, you know, we've got subscription food boxes now, we've got subscription veterinary services where, you know, they've got, you know, they're fleeing wormers in.

Included every month and so on and so forth, and you know, they will pay that money because they know it's for the best of their, their pet's health. But what, what opportunities are there for us to look at as clinicians to say, look, you know, this is this new generation of pet owners who behave differently, who, you know, we, we've noticed in the UK there's a drop in people getting driving licences, there's a drop in people, you know, doing all of these things that actually facilitate a physical visit to the vet. So you know, what, what opportunities and trends are you, are you guys seeing in the states that, you know, inevitably will trickle across over here as well, that, that, that's giving vets opportunities for how to enhance that relationship.

Yeah, I think that's a great question, and I think it stems back from understanding the ideals again, and priority of the millennial pet parent. So we know from and sort of correlated amongst many different surveys of independent groups that millennials. They want a lot of choices.

So they want a wider range of products and services. They don't just want a veterinarian to come in and say, this is the plan dictated across the table or a phone with no options whatsoever, and then just expect the millennial pet parent to just say, OK. That, that, that relationship of that sort of historical, very, very traditional kind of directional, communication is, is no longer going to work.

So if we're doing that in practise, that in itself needs to shift. But the millennial pet. Parent is very much into understanding information.

They want the research. Many come in already having done their own research, perhaps insights and with other influencers that you may not agree with or certainly disagree with the accuracy of that information. They also want to document their journey on social media, and they want to interact with other pet parents who enjoy similar journeys and veterinarians who appreciate and also engage on social media, and they do prioritise quality over price.

So I think that's a very important distinction, and I think a misconception that many people here is, oh, millennials, you know, they're very frugal, and they certainly want to know everything about cost. I think there's a difference between being frugal and just being very thorough in understanding all the variables involved in the decision. And that's what millennials want is they want you to be very transparent.

About where your shampoo that you're recommending for this patient with chronic dermatitis, where that shampoo came from, what the company is about, what their mission is, you know, where everything was sourced, how transparent they are, and that you also find those those topics very important to your recommendation, what the price is and what the value is to the client. And when those are discussed, you know, again, that's a very trusting relationship you're developing. Hm.

And I think that's it, isn't it, that whilst they may not ask those questions during the consults, they're a product of a generation and a society, that those are the questions that are burning in the back of their minds anyway. So even if you as a person, as a clinician, don't get those questions, you can know that they're gonna go away and research stuff afterwards and go, well, before I cover my dog in this shampoo twice a week, and leave it on it for 10 minutes, I'm gonna check that, you know, no areas are. Forest have been destroyed.

And of course, not every client is going to go to this extreme, that's far from what we're suggesting. But these kind of things shape the behaviour of of that next generation, and ultimately the generation after that, because they will learn from the guys ahead of them, and it will shape the future of the veterinary profession. So, in terms of, obviously, you know, looking at dermatology and looking at dermatological cases, what can we as vets do better?

And that's not to say that everyone's garbage at doing this at this moment in time, but there's always room for learning. And how can we evolve our approach to our case engagement when any client comes in or we speak to them digitally, and to say, look, these are our desired outcomes for this case, these are yours desired outcomes, this is how we work together to get there. Yeah.

So, another great question, and I'll have a, a little bit of a long-witted answer. So stick with me, cause I think there's 3 big opportunities for dermatologists here to really, again, embrace the millennial wants, and understand their behaviour, but also find a way to marry what you need to communicate to them. In a communication style to understand and appreciate.

So before we get into those opportunities, I do want to stress that the most important thing right now for dermatologists to be thinking about is their digital presence and their website. Because that's where your first impression really is with the client, that's where people start developing online reviews, that's where they look for something that's modern and user functional and easy to find information. That's where they look for your information library to find the reliable information you want to communicate.

That's where they look for an app to be able to communicate with. That's where they look for, your social media handles to make sure that you are appropriate and focused. So, as long, you know, if your website does not tell your practises story, like if you look at that website and you're like, I don't even know where did I even get that picture, you know, if it's not real, and it's not telling your story, then I strongly encourage everyone, and I've done this myself, to outsource and find someone who can help you tell your story the way you want it.

Because We as veterinarians, we wear way too many hats during the day. And if you're a practise owner, I know you're doing it because I've done it myself. And if you're not feeling like that's your wheelhouse, which most of us did not go to school to learn how to build websites appropriately to tell a story, outsource it and find someone who can, because that's really what's gonna drive people to your practise.

So, again, that's where you're gonna house these three opportunities. The first, of course, is telemedicine. And this has been, of course, a trend in human medicine and with the pandemic that's just escalated into importance of how, how much and how invaluable it is to helping with public health.

But in veterinary medicine, we know that the trends are to not see the veterinarian, especially with cats, whether those are founded or not, and I can get that, get to that in a second. But especially for rechecks or for triages, or for first opinion consults, where someone is trying to understand if they have a rapport with you. If they're trying to understand, do I need to see the veterinarian?

If they're trying to see all of what you just told me at my last visit, is it improving? Is our pruritus scaled down? Do we see any kind of, you know, new lesions or hopefully resolving lesions?

There are two types of telemedicine, because I know a lot of people think, Oh, God, I gotta be on a video call for an hour with a client. How helpful is that really gonna be? Synchronous telemedicine is that true real-time video to video.

And I'm not suggesting that everybody change their practise to go to that, because that is also somewhat daunting to implement right away. But don't forget there is asynchronous telemedicine, which is where a client sends you an email with all of the information you're gonna prep them that you need. So you're gonna need good photos with natural lighting and a good digital camera, and information about the distribution of the lesions and what they're seeing and colour changes, and all these kinds of things, where they can send that to you and at your leisure, in your scheduled time, you can respond to them.

And again, start that conversation that way, which is a great trust builder and also very helpful for people right now who are immune suppressed and don't want to be out into a public space. People who are caregivers, people who just, again, don't physically feel comfortable coming to the veterinary office. It's a great way to start.

In that same arm, dermatologists also can be teleconsultants, which within the US we only have 300 dermatologists and 87 million pets. So if you think about how do we service that pet population, it's just impossible for them, for especially some of those dermatologists are in areas where a client might have to drive 3 to 4 hours to reach them. So offering teleconsulting to your primary veterinary referral base is a wonderful way to bridge that gap.

So the primary veterinarian can see that patient, develop that case history, take pictures, talk about what they've done so far, and then reach out and have a teleconsultant communication with you. So you can be giving direction on that case, further diagnostics, assessments, treatment recommendations. And obviously that helps not only bond that client to the primary veterinarian because they now have this additional consulting piece they can offer, it bonds you to the primary veterinarian themselves.

So now you have again, this new referral base, and then as a dermatology practise. You have now a new source of income, especially for other associates who may want to join your practise who want to work from home or remote or have more flexibility in their hours. So I think it's a great way to think about how to expand your service again through telehealth.

The second thing is wearable technologies. So globally, this was a, as I think in 2016 was a $1 billion business, OK? So we need to think this, this is there to stay, and that's not just GPS technology and microchip technology.

So this is what I'm talking about are these activity and behaviour monitors that pets can wear. That give us continuous information on sleep and eating, and for our purposes in dermatology, things like scratching and shaking. Right?

So we can get a very objective viewpoint, even for people who say, I'm working from home and I never let my dog out of my sight, 23 hours and 59 minutes a day. Even for those clients, we can get objective data on our chronic otitis patients, right? How often are they shaking now after we've treated for two weeks?

On our pruritic patients, fluid allergic dermatitis, atopic patients, even food allergy patients, and also just restful sleep. And we No, itchy dogs are really uncomfortable and their quality of life is diminished. Many new pet parents don't understand that concept.

They certainly can recognise, arthritic pain, right, as pain, but they don't understand that dermatitis can be very uncomfortable and affect quality of life. So restful sleep is so important for us to understand. And that's a great way to add, again, this sort of telehealth spot to your patients.

The big pain point there is, of course, who Who's going to interpret all that data? And are you going to have a pet parent who says, I'm gonna share every hour of every day with you and want your advice. So that's where you employ our very beloved superheroes of the veterinary profession, our veterinary technicians and nurses, to come up with strategies within your practise and how do we interpret it?

And do we just, you know, average that. There's also now artificial intelligence that can analyse the data for us and just take it and give us a report, which, of course, is very helpful and efficient. And then the third aspect, and this is more for the people doing in person, but also just again, for your patients in hospital, is the concept of fear-free dermatology.

So the quickest way to lose a pet parent today is for them to witness, whether it's on FaceTime or Zoom or in person, their pet seemingly being uncomfortable during a test. Whether it's a skin scrape or a plucking, or some other type of biopsy, if they are witnessing that patient or their, their family member being uncomfortable, they are gonna be uncomfortable and that destroys your trust, and that destroys your bond, and that could destroy your client being part of your practise. So what we want to understand is this concept of fear-free, which is, you know, the, the mission of Fear Free was started by Dr.

Marty Becker, is to reduce fear, anxiety and stress in our patients, and to also inspire and educate the caregivers of those patients to do the same. So, by reducing fear, anxiety and stress in our patients, we're also reducing our own, which improves practise, quality, and certainly lessens compassion, fatigue, and all of the mental health strains that we know our profession deals with around the world. So looking at our patients, what we want to do is think of that journey in the pet in the practise as truly that.

It's not just pieces that you're doing. It's that from the time that that pet comes into the practise, how can we encourage a very emotionally healthy journey? Keeping that patient in the same room at all times, not shifting them around so you don't have to keep acclimating to new experiences and smells.

Making sure you're doing the least invasive test first, like a cytology, and the most invasive, like a skin scrape around the face last. Coming up with substitute testing if possible, depending on the parasite you're looking for, and maybe Doing pluckings or tape preps for different, testing as alternatives. Giving them a spa-like experience within the exam room.

So using pheromones to relax them, calming music, lick feeders and slow lick mats to encourage high reward treats, giving clients similar things to do at home so that the car ride. To the veterinary office is is less stressful, giving them things to combat bathing fear at home, you know, freezing peanut butter and smearing it all the way around the tub, making sure they have a non-skid mat, and making that experience a positive experience, which encourages compliance. So looking at all of these things and showing why they're different, why that patient coming to ABC dermatology practise is going to have this better emotional journey because we understand the physical and emotional health of our pets.

So again, in such a long-winded answer, thanks for bearing with me. I think there are 3 really big opportunities here and again and again, that's in the area of telehealth and telemedicine, which also includes teleconsulting. This wearable technology for true objective tracking at home and integrating that data into your medical record.

And then finally the area fear free and truly embracing that we're taking care of pets, not only their physical health, but their emotional health, and that in turn takes care of our millennial pet parents' emotional health as well. I mean, I, I, that sounds really, really exciting for me, it's really it's really interesting to see how we take this opportunity, and I really do see this as an opportunity for us as a profession. To evolve how we engage with clients and make that vet, you know, we know that that we're an essential part of pet owners' lives, but we have a real window of opportunity here to, to better engage with them.

And I think, you know, it's very rare that actually chances like this come along for a whole profession to evolve its approach in a very, very short space. Time really. So I think, you know, dermatology being one of those areas that really can benefit from me.

So I'm really, really looking forward to to hearing you chat at WCBD 9 at the Siva symposium. Thank you so much for joining us, and I'm certainly looking forward to finding out a lot more about this evolution of these pet owner behaviours. So thank you very much for joining us.

Thanks for having me.