The Veterinary Industrial Complex

4X4Dodger wrote:

Secondly my main point about large vet practices and the amount of money they MUST bring in to pay the salaries, overhead, service debt et. al are real world and there is no denying that there HAS to be tremendous pressure to increase income at every opportunity to meet those costs, to say nothing of profit or a decent living for the Vet.

It depends on what the extra employees are doing. Are they really unneeded, a product of poor management? Then sure prices will have to be raised to meet the extra cost. Or are they productive employees who are bringing in money to the practice--are they groomers and boarding kennel attendants and things like that? If so they're making money for the clinic. In most clinics nowadays the vets aren't the only ones who generate income.

Dr. Doug, I appreciate your thoughtful words. Thanks for taking the time to share them.

I used a vet for many years that was small -- it still is a relatively small practice. What changed for me wasn't the care I received, but the way the office was run. For some reason the front office became impersonal and pretty unwilling to talk with me, especially when I was traveling & needed support. Used to be I could call, talk things through with some of the techs, and they would in turn talk with the vet and get back to me. That changed, and after close to 15 years I moved my pets to another practice.

Veterinary care is definitely an art. And I like being able to have a thoughtful dialogue with the vet when it comes to working out what's best for my pets. When a practice's front office prevents that from happening I feel like I have no other choice but to find a practice that will give me the kind of support I want.

Laura

dturm wrote:
I have avoided commenting on this topic. While I believe 4X$Dodger’s observations may be accurate, I don’t feel all of the conclusions are warranted.

It is true that with the technological improvements and increase in knowledge have changed the field of veterinary medicine. This offers a much wider understanding of animals and their diseases and so many more options to deal with them. This does come at a cost, but the benefits are real. To say that this is “harming pet care overall” just isn’t warranted.

Another aspect to what has happened may be a misconception that many have about medicine. There is a reason it’s call “the ART of medicine.” So many think all you have to do is run a test, take a blood sample, do a radiograph/mri/ultrasound and you have an answer. That’s just NOT the way it is. Diagnosis is hard and many conditions/diseases don’t follow the book or multiple diseases are present at the same time and complicates our job. It’s sad to admit how many times we guess about what’s going on – with some pretty good evidence and reasoning – but still a guess.

You can end up spending $$$$ and still not have an answer or the answer you want. This situation can result in frustration and anger aimed at your vet. This situation is more often unreasonable expectations compounded by poor communication.

I hope the profession has not gotten to the point where needless tests or procedures are done in the name of $$$ or CYA.

I know after running a 4-5 doctor practice with 15 employees, the decisions about equipment purchasing can be difficult. It has always been about patient care, not income generation. Business decisions were never about the equipment purchase then pushing utilization to justify cost. It's always about the need for utilization for patient care to justify the cost.

There is no doubt that veterinary care costs have risen. It is also true that there are some veterinarians who push the best care/technology/medicine available.

You always have a choice and I still believe that veterinary care in this country is a bargain.

Doug, DVM

I think that first off you must admit that as a Vet you come to this discussion with a built in bias. Regardless of your good intentions and however you may operate your practice you cannot extrapolate your actions to most or even many vets.

My Biological Father was a Doctor and head of a hospital, My nephew is a head and neck surgeon (Otolarangologist) My sister in Law has been an OR and ER nurse for her entire career. As a former Cancer patient with stage four Squamous cell carcinoma of the head and neck I am not naive about medicine or the challenges of Diagnosis OR the financial issues involved in private practice.

I do agree that medicine is partly an art and intuition and my point is that is exactly what is lacking at so many vets now.

And while the decision to purchase a particular piece of equipment may indeed pivot on a patient care analysis you still must be able to pay for that machine. Which means it MUST be used. It must carry it's own weight, financially speaking.

The vets that own their own businesses are essentially businessmen. You absolutely must make payroll and all the rest of the expenses and turn a profit if you are to survive. Now we all know that most Vets and Doctors try to keep out of money discussions with patients. This is simply smoke and mirrors. Of course you know what it all costs, otherwise you wouldnt be in business long.

I know it makes Vets and Doctors uncomfortable to talk about business and money but the reality is that it is part of what you must do.

As for poor communication and out of line expectations, I agree these can complicate things, however in my direct experience it is the Vets that are not listening or questioning nearly enough. Despite telling one Vet repeatedly that Nigel WANTED to eat But could not bring himself to do it, he continued to use the phrase in conversation and in writing that Nigel had no appetite. This was clearly not true. He did have an appetite and wanted to eat but no matter how he tried he just couldnt bring himself to do it. The second vet we went to got this point.

And lastly I am afraid that Vets have long since been ordering tests to up income AND to mitigate liability.

And no I did not have unreasonable expectations nor am I not able to communicate clearly and precisely with the Vet or any other doctor for that matter. But what I saw and experienced were real and when put together with many other Vet visits all across this country I can say with surety that in many cases Vet/Pet care in this country is needlessly expensive, (sometimes more than a human doctors visit)and less about what is actually needed for the patient than generating income to support overly large practices.

Happily the Vet that put Nigel out of his misery we found in a small town in Oregon. He was by far the most concerned, compassionate vet we had seen. He was a one man practice with about two or three employees. His goal was CLEARLY centered on Nigel and his well being.

Technology is a tool only a tool and it can often give misleading or outright false results. (my cancer was misdiagnosed twice) but too often it seems that it has become a crutch in diagnosis rather than one of many tools including intuition, experience and that elusive "ART" that also needs to be brought to bear in patient care.

I have avoided commenting on this topic. While I believe 4X$Dodger’s observations may be accurate, I don’t feel all of the conclusions are warranted.

It is true that with the technological improvements and increase in knowledge have changed the field of veterinary medicine. This offers a much wider understanding of animals and their diseases and so many more options to deal with them. This does come at a cost, but the benefits are real. To say that this is “harming pet care overall” just isn’t warranted.

Another aspect to what has happened may be a misconception that many have about medicine. There is a reason it’s call “the ART of medicine.” So many think all you have to do is run a test, take a blood sample, do a radiograph/mri/ultrasound and you have an answer. That’s just NOT the way it is. Diagnosis is hard and many conditions/diseases don’t follow the book or multiple diseases are present at the same time and complicates our job. It’s sad to admit how many times we guess about what’s going on – with some pretty good evidence and reasoning – but still a guess.

You can end up spending $$$$ and still not have an answer or the answer you want. This situation can result in frustration and anger aimed at your vet. This situation is more often unreasonable expectations compounded by poor communication.

I hope the profession has not gotten to the point where needless tests or procedures are done in the name of $$$ or CYA.

I know after running a 4-5 doctor practice with 15 employees, the decisions about equipment purchasing can be difficult. It has always been about patient care, not income generation. Business decisions were never about the equipment purchase then pushing utilization to justify cost. It's always about the need for utilization for patient care to justify the cost.

There is no doubt that veterinary care costs have risen. It is also true that there are some veterinarians who push the best care/technology/medicine available.

You always have a choice and I still believe that veterinary care in this country is a bargain.

Doug, DVM

Thanks to all who conveyed your condolences. Nigel was a great pooch who came as a a puppy from a shelter and he is sorely missed for sure.

Pawz4me wrote:
I'm sorry about Nigel.

But . . . your experience isn't universal, and thus your observations very likely aren't entirely accurate. The vet group I use employs way more than eleven people. And yet I've never felt rushed or pressured to have testing done until I had time to think it over.

Well to say that what I observe is not accurate may not be what you meant but I can assure you it is accurate. As someone who has owned and operated large and medium sized businesses and came from a family who did the same I can pretty much look at a business and tell you how much it's costing to run it. I also must point out that I didnt say or imply that it was universal. But it is a growing trend for sure already entrenched in many practices.

Secondly my main point about large vet practices and the amount of money they MUST bring in to pay the salaries, overhead, service debt et. al are real world and there is no denying that there HAS to be tremendous pressure to increase income at every opportunity to meet those costs, to say nothing of profit or a decent living for the Vet.

This is just plain business sense. And in my view this is raising vet costs out of all proportion to other costs and resulting in an overall skewing of what is truly important and harming pet care overall.

I agree with Colliehauler - I wish I could get medical care from people who are as caring as my Vet. And this past December, when Jimmy developed an allergy to flea bites and I had to find a Vet in Florida, I again found someone who was caring, and offered me several approaches to his treatment. But I guess I've been lucky that my dogs have not required more specialized treatment.

My sympathies on the loss of your Nigel (((HUG)))

Sorry about Nigel its hard losing a good friend.

My experience with my local vet could not be more different. Compared to human health care I consider my vet a bargain. Same with the vet I use at my seasonal site.

Now with that said when I took Collies to K-State cost were higher and not near as personal. I lost Bud this year to what the vet's and I thought was a brain tumor. To do a MRI at K-State to confirm was $2000. dollars which I opted not to do.

I'm sorry about Nigel.

But . . . your experience isn't universal, and thus your observations very likely aren't entirely accurate. The vet group I use employs way more than eleven people. And yet I've never felt rushed or pressured to have testing done until I had time to think it over.

First, I want to extend my condolences for you over your dog Nigel. He was fortunate to have you in his life to help him along at the very end.

We are facing a crisis with our one Scottie. It appears she has bladder cancer. We are finally in Indiana and on Monday she goes to the Purdue Vet School where the head researcher on Scotties and bladder cancer is going to have a look at her.

We, too, have seen a lot of changes in veterinary care and like you. . . we still prefer our small hometown vet. He saw her this last week. He does what he can to mitigate the costs we face, explaining what generic drugs I might be able to buy for her at Walmart. He advises me on modified tests or specific tests that can yield results without running the entire battery. He has often made suggestions when we were on the road about what to look for in finding a vet who can help us. I will be eternally grateful for him. He is actually semi-retired, but we continue to see him.

I took our little gal to a one vet this year in Texas who wanted to run a bunch of tests. They kept coming back negative and then her tech yelled at me for not continuing with an NSAID which was causing extreme complications with my dog. . . like I didn't know what was causing the problem. When I wanted an ultrasound they told me $4-500! Yikes. The one I had done last summer was $65. So I found another vet. He is very much like our "regular" vet and I know we will continue to use him when we get back to Texas. Those kinds of vets are still available, but I know to stay away from the large conglomerates which do seem to be interested in making $$. I don't mind paying my vet because I know he doesn't pad the bill. It still is expensive, but I know I'm not going to be paying for a lot of unnecessary stuff.

Also, our regular vet and the new vet we found in Texas both provided me their personal emails so that I can relate to them what the Purdue vet finds. They are both interested in our little gal and hope that we can help her get a few more years. The other vet that ran all the tests and yelled at me has never called to check up on her.

Dale