Veterinary Care in the Age of Having it All

I want to tell you a story.

A young veterinarian has been practicing mobile veterinary medicine in a small, close knit community for the past several months. She has been received well, especially as an outsider. The town is so small that there is only one other veterinary practice with two veterinarians in the town. She recently decided to open a brick and mortar practice in order to better serve her clients and expand her business.

The community members have been stopping by regularly to see the progress being made on the new clinic and make small talk. One fine spring day while she’s working on her new reception area, the mailman brings her a letter from a gentleman she had spoken to briefly the day before. Intrigued, she takes a break from working and sits down to read. 

The letter goes something like this. 

Dear Dr., I am so happy that you are going to remain in our small town and be our vet. I thought I would pass along a few words of advice as you open your practice. 


1. Be excellent at your job, and show us that you really love animals. The other vet doesn't know what she is doing. 


2. Most people living here are retired and are on a fixed income. A senior discount would attract clients. 


3. It is important to us that veterinary costs are kept low and are reasonable and fair. The other vet is greedy and clearly only cares about money as she charges way too much. 


4. If you don't plan to be open daily, leave a phone number where you can be reached in times of emergency.


I hope this will help you.Best,
Resident Senior


____


What exactly was the intention of this letter? With what tone do you read the letter? Do you think the requests are "fair and reasonable?" 


To break it down, this is what the letter is requesting (or demanding, depending how you look at it):
- Excellent care and compassion 
- Low cost
- 24/7/365 access to this vet. 

Sounds great, right? This is exactly what you want from your vet, right? While I think the letter was written with good intention, the letter writer is asking for an ideal that is impossible in the current day and age. I am going to try to explain why this combination does not exist.

24/7/365 No one works 24/7. Do you ask your mechanic for his cell phone number so in case your car has a problem at 11 pm you can call and ask him about it? How about getting your kid's teacher's personal number so you can call with homework questions? It is not fair and reasonable to expect your vet to work 7 days a week and answer your phone calls at all hours of the day, and if your vet does do that (as the market in this small town might require because it is too small to support an emergency clinic), then that service will come at a premium. Being on-call creates a terrible quality of life (1). You are a slave to the phone, feel like you can never go anywhere or do anything because what if there is an emergency. You start hearing your ringtone in your nightmares and feel a sense of dread whenever your phone rings. Not to mention the effects of being “at work” 24/7 have on your family. With the exception of OB-GYNs, even human medicine has largely eliminated on-call because of this. And if you have to be on-call, it must be worth it. So there will be an associated cost. 

Fair and Reasonable Cost Everyone has a different definition of “fair and reasonable” pricing. The truth is that some people will complain even if the exam fee is only $10. But to the vet, fair and reasonable means being able to pay for the cost of maintaining the facility while remaining affordable for clients. Most vets are not greedy. Truly. Yes, there are a variety of types of people in every profession, but most vets really do want to help you for as low cost as possible. I think sometimes pet owners forget that vet practices are in business. They have to charge in order to keep their doors open, and there is no government subsidy like there is for human hospitals. My boss pays the mortgage, electric bill, water bill, payments on the x-ray machine, the blood machines, fixing and replacing instruments as they wear out, paying the lab and the outside services we use, purchasing all the materials and drugs we need to run the practice, then fairly compensate all the staff. Well paid staff work better. They like their jobs more, do their jobs better, and less mistakes are made when people are happy. That translates to better care for your pet. And the cost of care has risen. Excellent, top notch care will cost you more.

Low cost clinics and options are available and serve an important purpose in helping lower income families get preventive care for their animals. The cost of a neuter surgery will be very different between a low cost clinic and a general practice. Low cost clinics are still profitable, but sacrifices must be made in order to cut costs. And those sacrifices are not to the practice owner’s pocket. To the pet owner, the cut costs are invisible. Two pet owners drop their dogs off for surgery, one at a low clost clinic and one at a general practice. The incision will look much the same, the bill will look different. Even though the procedure was the same, things were done differently in order to save costs at the low cost place. Just don’t translate that low cost to mean that your regular vet is OVERCHARGING you. Each is charging appropriately for their services. 

Excellence This request is the only one I feel is reasonable. Like most people drawn to veterinary medicine, I am a Type A perfectionist personality, and I want to offer the very best of care while being compassionate to my clients and patients.  Being compassionate doesn't cost me anything. In fact, being the opposite WILL cost me - it will cost me my clients, business, and reputation. However, gold standard care does have a cost associated with it. In order to offer digital xrays, ultrasound, the safest anesthesia, diagnostics to obtain the correct diagnosis - we the veterinary clinic have to pay. We pay in time spent learning, and we pay for the raw materials. We cannot eat those costs and be profitable.


The cost of care is a complex issue. There are many factors at play, and due to the increasing sophistication of veterinary care, which meets or sometimes exceeds that of human medicine, costs have risen. In veterinary medicine, we are struggling to find a medium between being able to provide gold standard care at a “reasonable” cost for pet owners. We don't want care costs to be so high that we can't treat and fix our patients. Veterinarians 'push' preventative care because preventative care is generally cheaper than fixing things after they happen. For example, heart worm prevention is  approximately $240 per year. Heartworm treatment is a one time cost of $3-5000. Pet insurance will help people cope with these rising costs for sure, but if pet insurance becomes like human insurance, the cost of veterinary care will increase.

Thank you for reading. My intention with this post was to offer some insight into why costs are what they are. I hope you have found this information valuable.


1. "Psychological Toll of Being Off Duty but On-Call"  https://digest.bps.org.uk/2015/09/10/the-psychological-toll-of-being-off-duty-but-on-call/

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