Banking on KC – Dr. Sam Franklin of KC Canine Orthopedics: Keeping Canines Active
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Welcome to Banking on KC. I'm your host, Kelly Scanlon. Thank you for joining us. With us on this episode is Dr.. Sam Franklin, who is the founder of KC Canine Orthopedics. Welcome Sam.
Dr. Sam Franklin:
Thank you for having me.
Kelly Scanlon:
I know that people are treating their pets more and more like families, and it's something that is probably, it's not just affecting the pet treat industry and the pet food industry, but the veterinary industry too, making more strides and trying to keep their animals healthy and alive longer. Would you say that that's happening, that you're seeing that?
Dr. Sam Franklin:
Yeah, there's definitely a trend toward increasing specialization of care and quality of care, particularly as there is a trend toward pets being considered family members rather than property, as an example. And so people want them to be healthier and happier and around longer and also more mobile, more capable of having fun for a longer period of time.
Kelly Scanlon:
Quality of life, companionship, all of those things. Canine orthopedics, that is a specialty. Talk to us about that particular specialty, what it involves, as well as some of the other veterinary specialties we're starting to see as a result of all the things that you just said.
Dr. Sam Franklin:
That's a great question. It's one I really like talking about. A lot of the pet-owning public is not really aware of how training and certifications in veterinary medicine works. All individuals go to veterinary school, which is four years, and then you finish veterinary school. And importantly, once you finish veterinary school and you pass the national board exam, you are allowed to do any medical procedure on any veterinary species, period. There is no limitation and no further regulation.
Kelly Scanlon:
So it's a very broad, you can work with large animals, you can work with cats, gerbils.
Dr. Sam Franklin:
Yeah. And as an example, you could finish veterinary school, be a veterinarian, and you could do heart surgery on a llama if you wanted. You could do a kidney transplant on a chimpanzee, technically. The point being is you're really able and free to do just about anything that you want on any species. So what you're really regulated by is what you as a veterinarian feels capable of and of course, what the pet-owning public want to allow you to do.
And I'll give you another example. So technically I could practice equine surgery, although quite frankly, I'm not even capable of putting a saddle and a bridle on a horse, let alone ride a horse appropriately. So even though legally I'm allowed to do surgery on a horse, I don't really have any business doing so, and that's just an important thing to keep in mind.
So after veterinary school, if one wants to go further in their training, they would do an internship or maybe multiple internships in pursuit of getting a residency. And then when one gets a residency, it's typically three or four years. There are residencies in everything from internal medicine to dermatology to cardiology to neurology to surgery to emergency and critical care, very similar to humans. And then at the end of that residency, one takes a board certification exam, and if one passes, then one can call yourself a specialist. Surgery and surgery residencies and surgical certification includes doing neurosurgery, general or soft tissue surgery as well as orthopedic surgery. So there are requirements for doing each of those different types of surgeries. And then the examination tests you in all of those. So technically, for example, I am a surgeon and not an orthopedic surgeon. There is no such thing as a veterinary orthopedic surgeon. Not officially. There is just whether you are a board certified surgeon or not.
Now, if we look at the human side, of course, we're fully aware that many individuals become very, very focused even within their field of specialty. Veterinary medicine is following suit to a degree in terms of there is a greater degree of specification in terms of one's skill sets and specialization. So on the veterinary side, because subspecialization is a newer concept and idea that is being approached in the following way, at least within the field of veterinary surgery. So within the field of veterinary surgery, there are now fellowship status being given to individuals who have demonstrated particular expertise in particular areas and or for surgeons who have completed fellowship, advanced fellowship training that goes even beyond the residency period. And so for example, there are fellowship status given to individuals in oncological surgery, which is cancer surgery, and there is fellowship status for performing minimally invasive soft tissue surgery, so like laparoscopic surgeries. And there is also fellowship status for minimally invasive orthopedic surgery. And that, for example, is a fellowship status that I have for the work that I've done, particularly in arthroscopy and minimally invasive joint surgery.
Kelly Scanlon:
What inspired you, first of all, to go into veterinary medicine and then to become a surgeon? And then third, I guess, why orthopedics?
Dr. Sam Franklin:
Yeah, those are great questions and they kind of turn into a little bit of a story. So I was in graduate school, always liked animals and liked the idea of conservation and wildlife and preservation. So I was doing graduate studies in essentially what you could say is like wildlife conservation, but decided that that was not really going to be a long-term rewarding career. I decided I wanted to move into veterinary medicine, another area where I could have that gratification of working with animals while doing so on a daily basis with contact with the animals, as just one simple explanation. So I went into veterinary school thinking that I would probably actually consider doing something like wildlife medicine, which it doesn't take you long to figure out that that is also a very difficult career and there's not really a whole lot of contact with animals.
And as veterinary school progressed, but very early, I found that I really enjoyed surgery. And then that was coupled with I've always enjoyed exercising. I competed athletically in college and beyond. And once I was done with that, the thing that always brought me pleasure was running with my dogs. And so all those things lined up together to having an interest in trying to be able to enable dogs and their owners to do the exercise that they really enjoy doing. And I use the word exercise and some people probably cringe because it sounds like a chore, but really what I'm referring to is the activity that they enjoy doing and they love doing because that's both enjoyable to give that to them. And then also the process for me, I enjoy the surgical aspect and the challenge of it and the immediate gratification of fixing something that is not working right. Those are the reasons that I ultimately decided that not only did I want to do surgery, but I knew even before I did my surgery residency that I really wanted my focus to be on the orthopedic side.
Kelly Scanlon:
We have a lot of business owner listeners and in addition to the science that you have to know in addition to the skills, the surgical skills you need to possess, launching a veterinary, especially a canine orthopedic service is a business effort. There's a lot of business side of things that you have to know. So talk to us about some of the special challenges when it comes to open a veterinary practice that you've encountered and others in the industry see on a daily basis.
Dr. Sam Franklin:
My answer is going to be not a very informative answer because the reality is that if I can describe it most simply in terms of what is needed, it is a team of individuals who each bring their relevant skillsets and abilities, including starting up the business. And so quite frankly, my greatest skill sets are the medical care and the orthopedic surgery and the sports medicine skills and expertise that I have, and also understanding how that care should be provided with regard to the members of the team. But with regard to the business side of things, we would not be where we are without my wife, so Ashley Franklin, who is a veterinarian who does have a great deal of business savvy and as well as experience. And so she has really been able to fulfill that role of providing a lot of the knowledge Dr.ive and decision-making with regard to the business aspects. So that's the first and important thing to point out.
Beyond those details that she handles in many ways, starting the business was at least clear because we were following again, a vision of what do we want the hospital to do? What is the actual medical care that we want to provide and how do we do that? And then every decision kind of fell from that and fell into place. And then the details that are not always so easy dealing with getting an architect and permits and loans and construction groups and hiring and the different attorneys that are required and managing employees and payroll and all that. Fortunately, I can tell you that I know something about all those things, but relatively little in comparison to my wife who's done such an excellent job of building this business and managing this hospital.
Kelly Scanlon:
We talked a little bit earlier about how the pet-owning public is demanding more. They consider pets as, particularly dogs, to be family members. So what are some of the trends that you are seeing because of those kinds of expectations?
Dr. Sam Franklin:
There are a few different expectations that come along with, again, the increased attentiveness and care that people are giving to their animals, but the activity that each individual dog and their owner does is different. The reality is that every dog and every owner really has some activity, and I mean even on the extremes. So you can have one dog and owner where they're like, yeah, the extent of what we do is we take a short walk maybe around the block every once in a while or we even just open the door to the backyard, have the dog go out, come back in, and then we snuggle on the couch, eat potato chips and watch movies.
But that's still some activity from the extent that the dog has to be able to meet those goals in order for both that dog as well as the owner to be happy. Similar to a person who, for example, says, "I compete my dogs in agility." And agility is a very challenging sport when we talk about the demands the dogs place on their bodies. And for a lot of owners of agility dogs, that is a passion and something that they dedicate substantial time to throughout the week and every weekend and traveling and events and competitions, and they want to be able to do that activity without limitation because they love it. So in turn, what that means is their expectation is that we give that back to them, that we enable them to do that, and that's our goal. Our goal is to provide that animal and their owner the ability to do that activity without hinDr.ance or limitation.
It's not possible to achieve that objective 100% of the time. There are some individuals, whether it is the severity of the injury or combined with age or combined with whatever the owner's goal might just be unrealistic.
Kelly Scanlon:
Let's talk about it from a technology perspective and a medical perspective. What are the breakthroughs and the innovations occurring in those areas allowing you to extend life, to adDr.ess injuries, perhaps critical injuries that before you would not have been able to do?
Dr. Sam Franklin:
There's at least a couple that I can think of off the top of my head. So one is because of the subspecialization. That means that the skill sets of the individuals providing that care are better. So anytime that anybody does something and only that over and over again every day, their consistency and their precision improve. As we in veterinary medicine and particularly in an orthopedic subspecialty practice, get to focus on fewer and fewer things that we do and do them over and over and over again, our consistency and our precision are better than the scenario in which one is doing multiple different things each week.
But then along with that is the equipment. So the equipment is improving and the equipment is improving in part because that subspecialization exists, and so that the companies recognize that this is an area of growth and an opportunity for them. So they're investing more in designing and producing more and more implants. As an aside, for example, one of the things I'm interested in doing more of is inventing new implants to be used.
Kelly Scanlon:
For example.
Dr. Sam Franklin:
For example, well, I can't provide too many details, but let's just say very generally, I could invent a new orthopedic implant and then I can go to a company and they are actually interested in the designs and what I've invented and interested in seeing whether or not they bring it to market because they recognize that there is this area for further growth and subspecialization within their industry, i.e., the implants and the equipment. And so the equipment is improving at the same time our skill sets are improving. And those two things hand in hand lead to an ability for more consistent outcomes with procedures that have existed for a long time, but also mean that we are doing newer and different procedures that have not existed before, providing treatments for patients where in the past one might say, well, this is how it's going to be, and now it is. Well, we can do newer surgeries.
Kelly Scanlon:
Can you give me an example of some procedures you could do that would've been just impossible, I guess years ago?
Dr. Sam Franklin:
One thing that's happening, I wouldn't say commonly, but it's absolutely feasible on basically a daily basis is to get a patient-specific implant or joint replacement made, meaning let's say you have a specific dog and they have damaged their joints so severely that maybe they need that joint replaced. But the custom typical off-the-shelf joint replacements might not be a great fit for that animal because let's say as an example, they have a deformity or degree of bone loss where the standard off-the-shelf implant might not be possible. One could actually have an implant and set of instrumentation made specifically for that dog based upon that dog's imaging and reconstruction of its limb and joint that is made only for that dog and then have it implanted.
Kelly Scanlon:
So as I'm hearing you talk about that, I'm thinking about innovations in other areas like 3D printing. How does that play a role or does it in what you do or what you just described?
Dr. Sam Franklin:
It plays a big role. I'll start with an example of how I use it very, very frequently, on a weekly basis, and then what can be done albeit less frequently, with the emphasis on cross-sectional imaging, which means like CT and MRI. And then 3D printing, one of the intervening steps in between is taking that information from a CT or MRI and turning it into a virtual 3D reconstruction of the human being or the animal.
And as a result, there is a great advance in software accordingly, including there is a lot of freeware that is supported by our national government, which any one of us can get on the internet, download the software and use it in order to do those things. And I do that on a weekly basis. So in a weekly basis, for example, I will take CT scans or MRIs, mostly CT scans, and then create three-dimensional models of a patient in order to look at those models, review them and make plans for surgery.
A subsequent step to take further would then be taking that information and actually printing the models, which that is done commonly, and that's very easy to do. And then the next steps after that include we'll now create a virtual 3D new implant for that individual and then actually have that printed. And then voila, you have a patient-specific 3D implants or instrumentation that can provide new options and new avenues for patients where in the past we might not have had that degree of ability or specificity.
Kelly Scanlon:
How common is your specialty, canine orthopedics?
Dr. Sam Franklin:
It is growing very rapidly. The previous practice I was in Colorado is one of the very first canine orthopedic specific practices, one of just, I'm going to say less than five in the country as of four years ago. I would say that at this point in time, there's probably at least 20
Kelly Scanlon:
In the country, so that's still a pretty small number.
Dr. Sam Franklin:
But I expect that every mid-sized to major city will have at least one orthopedic subspecialty practice within the next five to 10 years.
Kelly Scanlon:
What are some of the most common injuries that you treat?
Dr. Sam Franklin:
Yeah, the most common disease process that we treat is degenerative cranial cruciate ligament disease in dogs, which I know is both a mouthful.
Kelly Scanlon:
Yes. Tell us what that means.
Dr. Sam Franklin:
And also probably doesn't mean anything. So instead what we'll do for a moment is we'll use the more common terminology, which is people just say an ACL tear. But other things that we do very commonly are arthroscopies for joint injuries, fracture repairs, joint replacements, and also non-surgical management. But I'm also double boarded, so I'm actually a board certified specialist in sports medicine rehabilitation, so the non-surgical side of things. And I have a great interest in the non-surgical side of things. Now that's a smaller part of our practice, but I think it's an important part of our practice.
Kelly Scanlon:
And so what would that encompass the non-surgical part? What sorts of procedures or treatments would you offer on that side of the practice?
Dr. Sam Franklin:
Yeah, so there's numerous things just broadly that can fit under the umbrella of non-surgical management. Within our practice and myself specifically, my greatest area of expertise is use of orthobiologics. You might think, what are orthobiologics? So orthobiologics is the term used to describe things like platelet rich plasma injections, autologous protein solution injections, or to use a common terminology, stem cell therapy. And so I've done quite a bit of research in that area and is an area of expertise. And so I do offer those treatments. And again, they make up by far the minority of the practice.
But that just coupled with the knowledge and experience regarding how to try and manage particular performance and working dogs non-surgically is important. And I think that the reason it is important is because a lot of people want to assume that when you're a hammer, everything looks like a nail and that if I'm going to a surgeon, they're going to recommend surgery. And I think that there's some truth to that. When you are a hammer, things look like a nail. But that is all the more reason why it's important for us to have training and expertise on the non-surgical management so that we can recognize when the best thing for a given patient is a non-surgical management rather than surgical, having that balance.
Kelly Scanlon:
So are there any tips that you can give our dog-owning listeners about the way to keep their pets in a happy state doing the things that they like to do, but avoiding injury? For example, we had a Border Collie for years, and she loved to run across in the yard and catch a Frisbee, jump in the air, come back down. And I know that was bad for her to come back down on her back legs like that, but she loved it. She was miserable if you wouldn't play with her. So how do you balance that?
Dr. Sam Franklin:
Yeah, and I love that you used the word balance because that's exactly what I was getting ready to say. It is a balance. In other words, sometimes I'm actually the one saying to owners like, "No, no, no, don't shut your dog down. I want you to be active. I want you and your dog to be happy." It's a balance between doing activity that is too risky and just imprudent versus not doing enough activity to really get the enjoyment out of life that you should. And so usually I'm going to be the one kind of pushing you to say, I really think we can achieve this objective in terms of the degree of mobility you and your dog should have. Now, how does one try and minimize risk of injury? I think that the answers there are going to seem very simple, but they are exercise daily, stay lean, stay fit, stay muscularly strong, warm up prior to activity to a degree.
And that is one that seems almost least intuitive or least applicable to dogs because they have absolutely no concept of that. Dogs do not... If a dog steps out of the back door into the backyard and there's a squirrel out there and they want to chase the squirrel, they're not going to think to themselves, I'm kind of stiff because I've been laying around for the last hour and a half. I probably should ease into the squirrel chasing thing for the next hour. They just go instantaneously.
The things that are easier for owners to control are going to be diet, daily activity and stay lean and fit. And that does come to one thing that we see is a pretty high proportion of dogs, pet-owned dogs are overweight. That's not an easy nut to crack. So I'm not going to imply that it is an easy thing to adDr.ess, but it is certainly an area where owners who are interested and what can I do, that is an area that we could work on.
That does lead into one other area when we talked about specialization that I also think is worth owners knowing just a little bit about. And unfortunately, it's not my area of expertise, so I can't provide great details, but nutrition is a huge area in veterinary medicine, huge. And when I say huge, I mean not only from the amount of business that's present and the financial side of things and the relevance of it, but I mean the degree of specification and quality that can go into many of these diets. There is a lot of science going into these very high-quality diets.
I think the big challenge for pet owners is figuring out which of those diets those are, because equally because the business side is so big, there are some diets which are really light on the science and maybe to a degree, the quality, but boy, is there a big push on the advertising in the marketing. And it's hard for an owner to know, well, which one should fall into the category of really being high-quality for my dog? And which one maybe isn't really that high-quality? But boy, their marketing campaign is great.
Kelly Scanlon:
What does the future hold for the industry and for you with your own practice. Where do you see it headed?
Dr. Sam Franklin:
There are a number of trends in veterinary medicine [inaudible 00:22:19] and some may not. So one of the biggest ones is that the majority of veterinary hospitals in the United States are owned by corporations now. So corporate consolidation of veterinary medicine is widespread and continuing, and it's going to continue. A lot of the times when a pet owner might have vision in their mind of a veterinarian who is out and takes care of cows and horses and then dogs and then cats. But really there's a trend toward specialization.
Similarly, if one has in your mind the image of a one or two veterinarian solo private practice, the trend is more towards practices that are owned by corporations, and there's good and bad things about that. Some of the good things, if we focus on some of the good things is it does bring in some areas a degree of benefit with regard to efficiency of business management, efficiency of advanced medical equipment procurement, which can turn into, as we talked about earlier in this conversation, improving the care that is provided, right? There are some advantages to it, but that's a trend that's going to continue.
And I think similarly, the trend of specialization within the veterinary field itself is going to continue. I think the trend that veterinary medicine is largely female is going to continue. That is not something that we have touched upon. I think the numbers are and have been for roughly 20 years, that probably about 85% of veterinary students are females.
Kelly Scanlon:
Wow. How long has that been going on?
Dr. Sam Franklin:
For ballpark, 20 years. So for example, I started veterinary school 21 years ago. My class had 134 veterinary students, and I want to say that probably, oh, I think 20 of us were men.
Kelly Scanlon:
Yeah, that's a big number of female veterinarians.
Dr. Sam Franklin:
And that's common. Again, I think the current estimate is that 85% of veterinary students are female, and that trend is not changing. It's not going back to more men. It's remaining largely female.
Kelly Scanlon:
So what does all this mean for you, for your practice?
Dr. Sam Franklin:
The trends of owners' increased desire and willingness to seek more and more advanced care and greater consistency, better outcomes, greater longevity and greater mobility really means a number of things are going to continue, in my opinion, and which are therefore important parts of our practice and what we want our practice to be. And so those things are continued progress and growth in terms of offering both the surgical and non-surgical aspects of care, whatever is needed to make a patient more mobile. And you may say, "Well, aren't you doing that already?" And the answer is yes, but we also want to continue with the trends of as new procedures are developed, we want to be helping with those.
But then this is where I'd say maybe we're a little bit unique that I want to be a contributor to the development of those new surgeries and implants, as I talked about before.
Kelly Scanlon:
You want to be one of the pioneers, the innovators.
Dr. Sam Franklin:
Correct. Similarly, I have longed... We, I should say we, because my wife has helped me with a number of these, done research studies in clinical trials, and we're doing one right now. And I am a firm believer that any center that is truly a leader in advanced has to be doing research. Because by definition, if you are not doing research and exploring ways to improve what is being done, then you're not the leaders. And so an area of-
Kelly Scanlon:
In fact, you're losing ground.
Dr. Sam Franklin:
Yeah, exactly. In other words, if you're treading water, you're falling behind. And so, one of the areas that we are going to continue to pursue and be interested and involved in is the clinical trials, the research side of things, and the innovation and the development. So I was actually in a doctor's office earlier this week, and I stepped in and I went with my wife, and I pointed to the sign as soon as we walked in because I loved it. And I even said to her, I was like, "I want that sign." Because they had a big banner inside the office and it said, today's clinical trials are tomorrow's treatments.
Kelly Scanlon:
Absolutely.
Dr. Sam Franklin:
And it is so true. So the groups that are helping push and learn and develop those newer treatments, it's going to require the research expertise in doing the trials, but it does mean that they're the employees to offer more to those patients, whether we're talking human patients or the canine and feline patients.
Kelly Scanlon:
Dr.. Franklin, thank you so much for coming and sharing really a wide range of expertise on this topic. It's been fascinating to talk with you, and thank you for jumping in there and the interest you have in making the advancements to being that pioneer as well. Thank you.
Dr. Sam Franklin:
Well, thank you very much for having me. I've really enjoyed this.
Joe Close:
This is Joe Close, president of Country Club Bank. Thank you to Dr.. Sam Franklin for being our guest on this episode of Banking on KC. KC Canine Orthopedics strives to be at the forefront of veterinary innovation, underscored by their state-of-the-art facilities, subspecialty expertise and desire to pioneer further innovation. Their commitment to advancing breakthroughs in their industry also highlights the spirit of entrepreneurship that Dr.ives Kansas City forward. Dr.. Franklin's vision and dedication have transformed KC Canine Orthopedics into a pioneering institution where the latest in medical technology meets compassionate care to improve the lives of our four-legged companions like my dog, Tulip. At Country Club Bank, we believe in supporting local innovators who make a difference in our community, and KC Canine Orthopedics exemplifies this dedication through their work. Thanks for tuning in this week. We're banking on new Kansas City. Country Club Bank, member FDIC.