Posts Tagged ‘financial concerns’

The Elephant in the Middle of the Exam Room

August 1, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Reasonable Expectations X: Saving the Best for Last!

February 18, 2011

This will be my tenth and final blog post describing reasonable expectations as they pertain to delivery of veterinary care (parts one through nine can be found at www.speakingforspot.com/blog).  This time, however, the tables will be turned- rather than describing what is reasonable for you to expect of your veterinarian, I am going to discuss what is reasonable for your veterinarian to expect of you!      

© Juli Dell'Era

Here are a dozen reasonable expectations.  By complying with as many as possible, not only will your vet and the hospital staff sing your praises, your efforts will directly benefit your pet’s health- and nothing is more important than that.       

  1. Arrive on time for your appointment. This means being present in the waiting room, not hanging out in the car finishing up your cell phone conversation or meandering with your dog outside the building (please read below about the importance of arriving with a full bladder, your dog’s that is). When you arrive late, not only will you and your pet be shortchanged on time spent with the vet, there’s a chance the staff will remain behind schedule for the rest of the day.  If you and your pet are new to the practice plan on arriving 10 to 15 minutes early to fill out necessary paperwork and be sure to bring all prior medical records including X-rays, ultrasound reports, and laboratory test results. (Old invoices are no substitute for the medical record). If you are tempted to arrive late because your vet consistently runs late, call ahead and chat with a front office staff member who will know if it’s “safe” to arrive after the scheduled appointment time. 
  2. If you suspect your pet has a contagious disease such as an upper respiratory infection, forewarn the staff.  For the sake of other patients in the waiting room, they may recommend that your little snookums remain in the car until it is time for the doc to see you.
  3. Unless instructed otherwise, do your best to bring your pet in with an empty stomach and a full bladder. This means taking the litter box away a couple hours ahead of time and foregoing the popular doggie p-mail spots outside the clinic.  Your vet may want a urine sample for testing and if procedures are recommended, better that breakfast was skipped.  Don’t worry, your dog or cat is unlikely to urinate on the hospital floor and if it does happen, guaranteed there’s a mop in every hospital!
  4. Please turn off your cell phone.  Not only is the ringing phone a distraction, answering it while in the midst of conversation with your vet conjures up adjectives I’d best not mention.
  5. Come prepared to provide a thorough history.  Believe it or not, your observations may provide more clues for a correct diagnosis than the actual physical examination.  In fact a solid history can make the difference between having to run one diagnostic test or five. Do some sleuthing around the home front to make sure there’s nothing unusual your dog or cat may have been exposed to. Your vet will want to know if you’ve observed any vomiting, abnormal stools, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits.  If you don’t deal with “poop patrol” talk to the family member who does!
  6. Bring along all of your pet’s current medications (including supplements, flea control products, and heartworm preventive) so your vet can confirm that everything is as it should be.  At a minimum bring along a written list of what you are giving your pet including the name, strength and frequency of any medications- not just a visual description of the tablet. (Many medications come in the form of small, round blue pills!). Yes, the information is in the medical record, but, you’d be surprised by how often discrepancies are discovered.
  7. Know the name(s) of what you are feeding; in fact bring along a label just in case.  It’s remarkable how often clients can describe the appearance of the bag or wrapper “to a tee”, but for the life of them, cannot remember the name of the product. If the diet is homemade, bring along a copy of the recipe.
  8. Do your best to directly answer the questions asked by your veterinarian, without a lot of embellishment.  For example, if your vet asks if you have been filling the water bowl any more or less than usual, your answer should begin with “Yes,” “No,” or, “I don’t know.” “I give her only bottled water.” or “She absolutely adores water.” is not the answer your vet is looking for.
  9. If your pet is sick, try to have all the decision-makers present at the time of the office visit.  If this is difficult to arrange, the person present should take notes, and even consider audio-recording the conversation.  This is useful since details inevitably get lost in translation, especially when traveling from spouse to spouse!
  10. By all means, let the staff know if your pet is aggressive.  All animals are capable of unpredictable behavior.  A savvy veterinary staff can usually peg aggressive dogs and kitties within seconds of meeting them.  Occasionally one surprises us and bites or scratches- either a staff member or the client.  Everyone feels terrible but it’s made far worse when we learn that the client knew it could happen, but failed to warn us.
  11. Yes, I know it can be awkward, but I strongly encourage you to discuss your financial concerns before services are provided. When it comes to ways to pay your bill, there is no standard veterinary clinic menu, though most accept cash, credit/debit cards, and checks.  Do your homework to find out which ones apply to your facility. What receptionist hasn’t heard, “What do you mean, you don’t take Discover?” 
  12. Treat the entire staff well.  I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending, or rude to one of my staff.  Keep in mind that everyone who works in the veterinary clinic plays an important role in keeping your pets healthy.   They all deserve to be treated with equal respect and without a doubt, the entire staff will know if this has not been the case. 

There, I’ve done it!  I’ve said what all vets long to tell their clients, and I sure as heck hope you’re not offended! Do you think these are reasonable expectations?  Are there others worthy of adding to the list?      

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook      

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.