The Veterinary Paradox

A very wise veterinarian once told me, "You can't love your patients more than their owners do."  It seems silly to think about, but it really resonates with me.  No one goes into the veterinary profession without a strong love of and desire to help animals.  We are a bunch of bleeding hearts; I know I am.  The problem occurs when people expect us to foot the bill for their animal's care.  Don't get me wrong; I very much doubt there are people who will walk up to their veterinarian and say "give me that drug/surgery/treatment for free," but people do have a habit of making vets feel guilty when they need to charge for their services.  I've often heard people say such things as "my vet is ripping me off," "I could buy a wing on this hospital for how much I've paid you," "can't you tell me what to do without doing an exam (ie, charging a fee)" and "can't you just help me out a little bit?"

Some of those comments certainly sound like innocent banter.  After all, who wouldn't want to crack a joke at the $1000 bill I just paid for my dog's emergency visits this past week?  (We tell my dog..."It's a good thing you're cute...")  It's most likely just a sticker shock reaction, but it still strikes a nerve.  The insinuation is that vets are getting rich off of ill animals at the client's expense.  Veterinarians go to school for 8 years (4 years college, 4 years doctorate) to learn how to treat animals.  It is super expensive to pursue vet med, with OOS (out of state) costs ranging in the 200,000 range.  The average starting salary for a veterinarian in private small animal practice is between 60,000-70,000.  Compare this with human medicine, where after the internship and residency years (both of which are options for the veterinarian, though not mandatory), the lowest paid physician (primary care) will be making 150,000 with the same amount of educational debt.  So veterinarians have a lot of bills.  And like any other professional in the world, they do want to take home some kind of paycheck at the end of the day.

Though pet insurance is available, most people do not take advantage of it.  That means whatever you see on the bottom of the bill is the total cost that you need to pay.  In contrast, in the human medical arena, you pay for insurance for yourself, your spouse, and your family (or receive such benefits as part of your employment package).  Insurance takes care of most of the cost of medical care, so all you see at the bottom of the bill is a $20 copay.  This makes people pretty unaware of how much medical care costs, and they often gawk at the price of veterinary care.

But this really brings me to my main point.  Consider this scenario: You are a veterinarian working at an overnight emergency hospital.  It is 2 in the morning and all other vet clinics in the area are closed.  A client comes in with his young dog that was hit by a car.  The dog is laterally recumbent and has labored breathing.  You rush the dog into the back where your techs begin to attend to the dog.  The dog needs an IV catheter, fluids, X-rays, and blood work at the minimum.  The client looks at you and says "How much is this going to cost?  I only have $50."  What do you do?  The dog is suffering.  Your emergency exam fee is $127 and that doesn't even cover diagnostics, treatment, hospitalization, or surgery if necessary.  The dog is young and could probably live another 10 or so years.  You don't want to euthanize a treatable dog, but how much of the cost do you eat?  $1000?  $2000?  $5000?  If the owner can't afford treatment for his own pet, should you take responsibility for the pet's treatment?  Or do you euthanize the dog, knowing that it will eat you up inside but you can't shoulder the cost for every person that can't afford to pay?

Veterinarians are faced with this decision every day.  I read an article once that quoted a veterinarian who comped $50,000 in one year alone for various people who couldn't afford veterinary care(!!!).  This doesn't even take into account the stray animals and wildlife that vets will often treat, or shelter animals that need care that they offer a discount for.  Is this fair for the vet?  Should vets be expected to lower the price for every client that can't pay?  Should clients who can't get loans from friends or neighbors expect to get a payment plan from their vet?  Should people who can't afford vet care not own pets?  I definitely don't think so, but I believe that some responsibility for care should fall to the owner.  And I definitely believe the veterinarian shouldn't be made to feel guilty when they charge what their education, overhead, support staff, and supplies are worth.  It's a difficult question with no easy answers.

Some food for thought...

DVM2016

Welcome!

Hi all!  Welcome to my blog.  I am an incoming veterinary student at a US school starting in August of 2012.  I will be updating with my vet school happenings (hopefully pretty frequently).  A little about me:  I grew up on the east coast and will be moving ~8 hours away for the first time.  A little nerve wracking, but also very exciting!  My interests lie in small animal medicine (though I hear cows are pretty awesome!) and I hope to pursue a specialty one day.  I can't wait to get started on this next chapter of my life.  I hope you'll join me on this journey.

In regards to the title of my blog, veterinarians are a special group.  While human doctors spend 7-10 years learning how to treat one species in a very narrow scope (ie, human cardiothoracic surgery), veterinarians are not required to pursue internships or residencies.  We graduate, pass our boards, and are licensed to practice on every single other animal species on this planet.  Of course, there are some similarities between species (pigs are extremely like humans, for instance.  Cows and goats are also pretty similar, because of their ruminant digestive systems).  However, it's a huge burden to the veterinarian to not only be knowledgeable about medicine for lots of different animal species but animal welfare and ethics as well.  Veterinarians have a saying that you'll find frequently on T-shirts and tote bags that "Real doctors treat more than one species."  It's a bit funny because, really, who can expect to graduate veterinary school and be proficient in every single species?  Not only do vets need to know all species, they also graduate as generalists, licensed in surgery, dermatology, behavior, neurology, cardiology, zoo and wildlife, and a myriad of other specialties.  It's a crazy profession, and that's what makes it so appealing!

For my first post, I'd like to point out a phenomenon that was apparent to me while I worked as a technician in a busy 24/7 ER and specialty hospital.  Namely, the difference between doctors who were technicians before veterinary school and doctors who were never technicians.  Working in emergency medicine is very high paced, and working the overnight shift provided some unique challenges that other shifts didn't require.  Namely, the requirement to basically run the entire hospital.  We were responsible for blood work (during the day, there were lab techs), radiographs (during the day, there were x-ray techs), inpatient treatments (during the day, wards were assigned their own technicians), triage (there was a triage tech during the day--are we seeing a pattern here?), comfort checks with clients, cleaning and restocking (usually left to maintenance), and running emergencies for the veterinarians.  Some nights were actually pretty slow (ie, only 3 patients in the entire hospital and no emergencies) but other nights it seemed like a free-for-all.  We would have stat after stat called over the loudspeaker (meaning, run to triage now!) and be expected to do a million things at once for a million different patients at once.  With 1 technician required to be in critical care at all times, this only left 3 technicians sometimes to run 3 stats plus 2 emergencies, take care of all x-rays, place catheters, draw blood for lab testing (and then run the labs), and attend to inpatients.  These nights were inevitably the nights that patients would pull out their IV catheters four times in an hour and soil themselves at every corner.  And every doctor expected their patient to take priority.  It was a tough gig, and I noticed that doctors who were technicians prior to veterinary school had an understanding of exactly how much work we had to do and when things weren't exactly done on schedule, were a little more understanding.  Others were not so nice about it.

With no further adieu, things I learned as a veterinary technician (minus all of the medical knowledge I gained, of course) that I will be taking to vet school with me:

1) Don't judge a client by their appearance.  I would hate when vets would assume clients wouldn't pay for expensive treatments when they looked a little unkempt.

2) Being a technician is hard work.  Appreciate your techs.  Good techs can make or break a practice.

3) I love emergency medicine.  This may change when I become the one who has to make the decisions, but I love the fast pace, the challenging and diverse cases, and the immediate impact that your decisions can have on animals.  (Though the hours kind of stink.)

4) Sometimes clients just need their hand held (figuratively, of course) through a scary time.

5) Every doctor likes things done their way.  (Why did you give pain medication?  The dog doesn't look painful and has pain meds in her fluids.  VS.  Why didn't you give pain medication?)  *facepalm*  It helps to be explicit in your instructions.  If you write PRN (meaning as needed) on pain medication and your patient is not painful, I will not give him/her unnecessary medication.  Don't write PRN if you really mean to administer every 3 hours, and then get upset when I can't read your mind. Something to keep in mind.

6) Some cats don't need to be scruffed.  Every animal is an individual.

7) Always keep an extra set of scrubs in your car.  Always (will never forget the night when I ran around with kitten diarrhea in my pocket).

8) It is really hard to listen to a cat's heart when they are purring.  Alcohol sometimes helps.

9) Animals get scared in the hospital.  Sometimes they need a little extra TLC.

10) People can get crazy about their fur kids.  It just means they love them.

11) Having euthanasia as an option can be both a blessing and a curse.

12) Being in the field meant I got to hold my own dog when we were preparing to euthanize.  I was able to go with her in the back to get her catheter placed.  It made the process easier to know I was there with her.  Animals being euthanized deserve an extra hug and kiss, because oftentimes, their families cannot be there with them.

13) Maggots are really gross.  So are worms.

14) It's important to be an advocate.  The vets I most respected refused to put up with BS when the animal's life or welfare was at stake.  It's a difficult balance between the client's wishes and the animal's welfare, but sometimes it helps to be persistent and firm.

15) Spay your dog (ugh pyometras...)

16) Male cats have tiny tiny tiny ureters.  They will get blocked.  Make sure they can pee.

17) Dogs get crazy when given lidocaine.

18) Be understanding to owners when their animals act up (and consequently, understanding of the animal's fears).  My cat is a devil at the vet.  So much so that the vet needed to towel him to auscult him, and he almost bit me in the process.  When clients say, "but Fluffy is so good at home," believe them and give them the benefit of the doubt.

19) Spending $1000 on your designer multichipoo does not mean that you are exempt from veterinary bills.  If you have $1000 to spend on a designer dog (no, your dog is not a breed.  Congrats!  You just paid $1000 for a mutt!), you have $200 to spend on emergency, life-saving veterinary care.  Don't try to make us feel bad when you don't want to (or can't) pay.  I will be graduating with $250,000 in loans and need to make a living.  This does not mean I am a soulless fish who hates animals.

20) I don't want to be a veterinary technician.

So there you have it!  Stay tuned for my next post!

~DVM2016