Tuesday, November 06, 2007

"How to Say No to Your Vet"

Last week, Slate published an article that ruffled some serious feathers in the vet world. Entitled "How to Say No to Your Vet", Emily Yoffe describes story after story of vets taking advantage of pet owners. Vets are in it for the money, she implies, and not to better the lives of animals and owners. Owners love their pets so much that they just can't help paying for the services that vets offer, whether or not they believe their pets need them.

While she has a point that vets should not take financial advantage of owners during crises (like the guy who brought his dead dog in to the vet) and the need for good, honest communication between vets and their clients, she also seems to imply that vets should not offer the best available care because after all, they are just animals. She writes:
I am grateful to the vets who saved the life of my beagle, Sasha, when she was hit by a car, and I quietly handed over my credit card when the bill for $2,000 came due (although I did manage to decline the offer of the special "orthopedic quality" fix of her injured ligament for an additional $1,500).
I'm impressed that she can be proud of the fact that she declined to get higher-quality care for her dog. She talks about it as though the vet were trying to add on options to a car. More expensive surgery is about providing a better fix, a more comfortable recovery, and a more reliable return to a normal life- not about adding on a deluxe package so you can tell your friends that your dog got human-quality care. By the way, if you get hit by a car, good luck getting out of the hospital only $2000 poorer.

The kicker to the whole article is her support from Dr. James Busby, the kindly old rural vet from Bemidji. Dr. Busby only offers the services his patients need, and says that he'd never enter veterinary medicine today now that it's in such a horrible state with so many money-grubbing vets. What Ms. Yoffe fails to mention is that Dr. Busby is on a limited license since he went before the Minnesota Board of Veterinary Medicine in 2002. Dr. Busby was performing sub-par medicine, including not examining animals before performing surgery on them, re-using dirty needles, sterilizing instruments in a solution that he changed only once a month, and performing surgery on animals using neither gas anesthesia nor oxygen. Ew. Not a great guy to hold up as an example of how vet med should be practiced.

Dr. Busby told Ms. Yoffe what she wanted to hear- that it's okay to only give minimal medical care to your pets. She thinks that vets should only offer the cheapest option, and anything better than that exists simply to line vets' pockets. Of course vets should be sensitive to financial constraints, but not offering high-quality care is just as rotten as not offering anything but the most expensive. I'm glad that vets understand the importance of preventative medicine. The author's daughter's pediatrician doesn't think a heart murmur is worth checking out with an echocardiogram, but her vet thinks the cat's murmur is? Sheesh, lose the pediatrician and start taking the kid to the vet.


Jeannette said...

The old adage "you get what you pay for" isn't always true. Our vet's prices are very reasonable and she provides incredible care for Zoe and Zelda. She comes from the old school where it's about the animals, not the money. She is concerned with the new wave of mediocre/poor ( I know from experience with both the cats and two dogs)and rising prices that places like petsmart and Petco are proving. I guess it all depends on who you go to.

Megan Watland said...

I wouldn't judge all veterinarians based on Petsmart (Banfield) and Petco (low-cost vaccination clinics). Visit individual practices and you will see that most clinics are not run the way corporate medicine is run.

To the idea that vets today are about the money- if I wanted money, I'd become an M.D. As it is, I'll leave school over $100,000 in debt (not including my undergrad loans) to make about $50,000 a year. If I'm lucky, someday I'll see $80,000 a year. In comparison, M.D.s usually leave school with about twice as much debt as I'll have, but they'll start out making about 3 times my starting salary (assuming they become general practitioners). Vets spend as much time in school as most other professionals, but make by far the lowest income. I'm not in this for the money- but I will need to charge enough to pay off loans and keep a roof over my head.

Cheap medicine doesn't mean that a vet is in it "for the animals, not the money." Not that your vet is a bad vet, but I've seen vets cut corners to keep prices low, and it's always at the animal's expense. Spays and neuters used to be performed sans anesthesia by hanging the animal by its front legs from a door. Cheap? You bet. Effective? Sure. Humane? No way. Standards of care will shift throughout time, and what was considered a good practice 20 years ago may not be so today. Pain meds are still considered optional after spays or declaws in some practices because "if the animal is free of pain, she might move around too much and injure the surgical site." The standard is quickly shifting since, hey, declawing or abdominal surgery hurts like hell, and it's cruel to leave an animal in pain after surgery. Keep the dog in a crate, or the cat in the bathroom, until normal activity is safe- don't deny pain meds in the guise of being better for the animal when it's really just more convenient for the owner (and cheaper, so you don't come off looking like a money-grubbing vet).

Expensive doesn't always mean better, but cheap doesn't always mean better either. Perhaps your vet has reached a point in her life where she doesn't really need much income and is only charging for the cost of materials, but can you really fault younger vets for needing to make enough money to pay back school loans and still make a living?

Bjorn said...

I'd say there corporate interests at fault with Banfield. Their volumes are huge, and they know how to pump as much money out of each customer as possible. That has nothing to do with the vets working there. I think things will get better as more people invest in insurance for their pets, to be able to provide more expensive care if the need arises.

Jeannette said...

Quite honestly I can blame younger vets for that. I can use the same argument for speech therapy. I could get the same results for a child if I charged a little for labor and supplies, or a lot for labor and supplies. I know that there is a cost for things, but I'm very passionate about what I do. I've seen what parents with little money would do for their kids, just like what I'd do for my cats. It should be about making a difference and being able to help as many people as possible, regardless of money. I personally don't give a damn how much money I make, and how long it takes to pay off my loans.

Chris Schommer said...

Blame younger vets? WTF are you taking about?

Vets are notorious for going pro-bono to bankruptcy because hey, animals don't really make any money them selves. They are at the mercy of their owners and if they don't think their dog is worth $300 to have a dental with out pain then screw em' they can not get drugged and get it done for $100 some place else. Often times these are older vets because they were taught the old way. New vets have tools that put old vet training to shame and provide much better care to the animal. 2 techs, an anisitiologist and a vet for surgery? Think that can get off for $75 like it used to? No way. So I say good riddance to the old school.

Megan Watland said...

I'm not talking about the amount of time it'll take me to pay back loans- I'm talking about being able to pay them back period, and if you think lenders will let you put off payments because you're making the world a better place rather than earning big bucks, you're sorely mistaken.

I'm not saying that a good vet can't do a lot with limited funds from a owner. But to imply that good vets shouldn't charge for their services because they're supposed to love what they do is just as silly as saying that your mechanic should fix your car for free because he loves cars so much. Charging a fair price for medical care is what allows a vet to practice high quality medicine. If I'm worrying about being able to make loan payments, or being able to pay rent or utilities for my clinic, or being able to maintain clinic equipment, my mind is not on my patients, and I am not practicing medicine to the best of my ability.

Vets have one of the highest suicide, depression, and alcoholism rates in the country. It's not because they feel so awful for stealing owners' money to fix imaginary problems, it's because they get sucked into a feeling of self-loathing that is perpetuated by the idea that vets should love animals so much that they shouldn't charge any money to help an animal out. When they undercharge, they can't afford to pay the bills. When they charge fairly, they can't forgive themselves for not treating animals for free. Fair? No way. But vets end up paying that cost, both literally and emotionally.

I'm not going to be shamed into feeling like I should care more about my patients than their owners do. Giving away time and products might make me feel good about myself, but it will seriously hamper my ability to practice quality medicine with those patients whose owners are willing and able to pay. Don't get me wrong, I know that I'll be undercharging some people and I'll definitely be volunteering my time for those animals who don't have humans to advocate for them, but if that's what I did all day every day, I'd be emotionally and literally bankrupt at the end of the day. And then what good could I give the world? A good vet can do a lot with little money, but you can't be a great vet until you get fair compensation for your work.

Megan Watland said...

I still say you can't look to Banfield as any sort of example of how vet med should be practiced. The only good thing to come out of Banfield is a gigantic database that actually spits out some pretty cool data if anyone takes them time to analyze it.

Other than that, they practice push-button medicine and push the most amazingly useless vaccine protocol on every patient, from the indoor chihuahua whose four feet never hit the ground to the outdoorsy hunting lab who routinely eats piles of unidentifiable goo.

Bjorn said...

Remember to step into client's shoes too. From their perspective, you're offering more services then they came in for, and charging a lot of money. They see that as greed. Unless you have a running total of your debt on the wall, no one cares how much it cost you to go to school. I run into the same problem with computers. I "should" charge you $300 like Geek Squad would for a house call. But, people complain about that, because for $500, they could just get a new computer, why should I pay you $300 to fix an old one? $2000 to fix my beagle? But, it only cost me $700, I could just get a new one. This is why computers, and pets should cost $15,000 like cars. Computers and pets have far more usefulness then their cost, but the cost to maintain is more then the cost to buy more.